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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”

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PROSIDING The 3rd International Nursing Conference (2019)

“Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”

Hak Cipta © Akper Keris Husada, Akper Pelni, Akper Cikini, Akper Pasar Rebo, Jakarta 2019 Hak Terbit pada Penerbit Akper Keris Husada Penerbit Akper Keris Husada Jakarta JL. Yos Sudarso Komplek Marinir Cilandak Jakarta Selatan Tlp./Fax : 021 7884 5502 Email: [email protected] http://akperkerishusada.ac.id

Cetakan pertama, Oktober 2019

ISBN: 978-623-91765-0-1 Desain cover & layout: Fitri Annisa, Ns.Sp.Kep.An Editor: Yuanita Panma, M.Kep., Ns.Sp.Kep.MB Fitri Annisa, M.Kep., Ns.Sp.Kep.An Hak cipta dilindungi undang-undang. Dilarang memperbanyak karya tulis ini dalam bentuk dan dengan cara apapun, termasuk fotokopi, tanpa izin tertulis dari penerbit. Pengutipan harap menyebutkan sumbernya.

http://akperkerishusada.ac.id/

iii

PREFACE

3rd INTERNATIONAL NURSING CONFERENCE

“Nursing Contribution at Disaster Risk Management:

Psychosocial Impact and Learning from Nations”

Asalamualaikum Wr.Wb, Good afternoon and welcome to

the THIRD INTERNATIONAL NURSING

CONFERENCE.

First of all I would like to thank Allah SWT, God Almighty

for the blessing of our conference today .

In this opening remark I want to welcome

- Associate Prof. Dr. Orapan Thosingha from Mahidol University, Thailand;

- Khortimas YOK Nursing Team Supervisor from Cambodia;

- Prof. Dr. Budi Anna Keliat, SKp, MAppSc from Universitas Indonesia;

- Masfuri, SKp, MN from Nurse Assosiation of Emergency and Disaster - Indonesia;

I also would like to thank

- The Chairman of PPNI, the Indonesian Nursing Profession Organization, today

represented by Mister Masfuri SKp. MN as The Chairman of the Foreign Affair

Division in PPNI.

- The Chairman of AIPViKI, The Association of Nursing Academic in Jakarta Mrs

Sylvia M.Kep

- The Chairman of YARSI Foundation Prof. Dr. Jurnalis for the outstanding venue here

in Arr-Rahman Auditorium.

And last but not least to

- The Directors of all four Nursing Academic ; PELNI; KERIS HUSADA; CIKINI and

PASAR REBO Nursing Academy for the partnership in holding this important seminar.

The purpose of the second Nursing International Seminar is to give global insights and

knowledge of the newest development in Nursing Higher Education.

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Aside from that, it is also a responsibility of Private Higher Education Institutions to develop

themselves not only in National but also International Scope.

Hopefully, all 900 (nine hundred) participants from Indonesia and abroad will have a fruitful

seminar with our Guest Speakers and the Oral Presentation from four Nursing Academies.

This event shall open a way for other international activities such as student exchange, lecturer

exchange and joint research. We humbly wait for the invitations from Thailand, Cambodia and

Indonesia.

Last but not least, please forgive all the mishaps to motivate us to be better in the future.

I hereby open The Second International Nursing Seminar, Bismillah

Chairperson of Organizing Committee

Ns. Tatik Setiarini,S.Kep.,M.KM

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TABLE OF CONTENTS

Cover

Preface ................................................................................................................... iii

Table of Contents ............................................................................................... v

Committee ........................................................................................................... vi

Conference Schedule ......................................................................................... vii

Oral Presentation Schedule ............................................................................... viii

Abstract and Full Texts of Oral Presentation

1. Sri Hunun Widiastuti, Achir Yani Hamid, Tuti Nuraini,

Novi Helena.. ............................................................................................. 1-12

2. Ira Sukyati ................................................................................................... 13-21

3. Ennimay ...................................................................................................... 22-38

4. Yenny, Krisna Yetti, Yusron Nasution ................................................. 39-52

5. IGA Dewi Purnamawati .......................................................................... 53-64

6. Siti Nurhayati .............................................................................................. 65-74

7. Yuanita Panma ........................................................................................... 75-83

8. Labora Sitinjak, Burhanuddin Tola, Mansyur Ramly .......................... 84-98

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The Committee PROCEEDING The 3rd International Nursing Conference Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations Jakarta, Indonesia (2019) The Chief : Ns. Tatik Setiarini, S.Kep, MKM Secretary : Ns. IGA Dewi P, M.Kep.Sp.Kep.An Treasurer : Ns. Lince Siringo Ringo, M.Kep, Ns.Sp.Kep.An Logistics Coord. : Buntar Handayani, M.Kep. MM Event Division: 1. Ns. Elfira Rahmawati, M.Kep, Sp.Kep.An 2. Ns. Henny Kusumawati, M.Kep, Sp.Kep.J 3. Ns. Samsinar, S.Kep

Scientific Division: 1. Ns. Yuanita Panma, M.Kep., Sp.Kep.MB 2. Ns. Fitri Annisa, M.Kep., Sp.Kep.An 3. Ns. Sri Hunun, M.Kep., Sp.Kep.J Food Logistics Division: 1. Tini Wartini, S.Kep., M.Kes 2. Reni Kusumawati, SH 3. Ns. Eni Sumartini, M.Kep

Documentation Division: 1. Ns. Sri Atun, M.Kep., Sp.Kep.J

Equipment Division: 1. Ns. Cecep, S.Kep., M.Kep 2. M. Sofyan Alkatiri

Editor:

1. Fitri Annisa, M.Kep., Ns.Sp.Kep.An 2. Yuanita Panma, M.Kep., Ns.Sp.Kep.MB

Reviewer : Ns. Tantut Susanto, M.Kep, Sp.Kep.Kom, Ph.D

ISBN : 978-623-91765-0-1 Cetakan : Pertama, Oktober 2019 Publisher : Penerbit Akper Keris Husada Jakarta JL. Yos Sudarso Komplek Marinir Cilandak Jakarta Selatan Tlp./Fax : 021 7884 5502 Email: [email protected] http://akperkerishusada.ac.id

http://akperkerishusada.ac.id/

vii

Conference Schedule

Dates Time Event

June 22th 2019

07.00-08.30 Registration

08.30-09.00 Welcome dance Opening Ceremony Sing “Indonesia Raya” Sing “INNA March” Welcoming Speech from:

1. The Chief of the Committee 2. The Chief Of INNA

09.00-11.15 1. Keynote Speaker 1: Prof Budi Anna Keliat, SKp, MAppSc “Overcoming Psychosocial Impact After Disasater: Guidelines on Mental Health and Psychosocial Support in Emergency Settings”

2. Keynote Speaker 2: Associate Prof. Dr. Orapan Thosingha (Thailand) “Emergency and Disaster Preparedness: Core Competencies for Nurses”

3. Keynote Speaker 3: Masfuri, SKp, MN “Nursing As A Part of Country Global Ratification for Disaster Risk Education”

4. Keynote Speaker 4: Khortimas YOK (Cambodia) “Disaster Nursing Research and Education: Now and The Future”

11.15-12.00 Discussion

12.00-13.00 ISOMA

13.00-16.00 Oral Presentation

16.00-17.00 Discussion

17.00-17.30 Door Prize

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Oral Presentation Schedule

Name Title Time

1. Sri Hunun Widiastuti, Achir Yani Hamid, Tuti Nuraini, Novi Helena

The Influence Of Group Supportive Therapy On Family Ability To Train &Quot;Self Care&Quot; Children With Multy Disabled Visually Impaired (MDVI) In SLB G Rawinala Jakarta

13.00-13.30 WIB

2. Ira Sukyati Analysis Of Factors Affecting Young Women Attitudes Toward Female Hygiene And Perineal Hygiene Behavior

13.30-14.00 WIB

3. Ennimay Evaluation Of Nurse Profession Education Program In Stikes Pekanbaru

14.00-14.30 WIB

4. Yenny, Krisna Yetti, Yusron Nasution

Analysis Of The Role Of Peritoneum Characteristics And Glucose Concentration In Drain Volume In CAPD Patients In Cci Cikini Hospital, Jakarta

14.30-15.00 WIB

5. IGA Dewi Purnamawati

The Relationship Of The Mother Education Level With The Growth Of Toddlers In Posyandu Rw 12 Puskesmas Kelurahan Gedong Jakarta Timur

15.00-15.30 WIB

6. Siti Nurhayati Therapeutic Play Optimalization In Pediatric Post Operative Pain With Levine’s Conservation Model Approach

15.30-16.00 WIB

7. Yuanita Panma Factors Affecting Depression In Hemodialysis Patients

16.00-16.30 WIB

8. Labora Sitinjak, Burhanuddin Tola, Mansyur Ramly

The Evaluation Of Indonesian Nurse Competence Standards Adapted With 4.0 Industrial Revolution

16.30-17.00 WIB

1


THE INFLUENCE OF GROUP SUPPORTIVE THERAPY ON

FAMILY ABILITY TO TRAIN"SELF CARE" CHILDREN WITH

MULTY DISABLED VISUALLY IMPAIRED (MDVI)

IN SLB G RAWINALA JAKARTA

Sri Hunun Widiastuti1 , Achir Yani Hamid2 , Tuti Nuraini3 , Novi Helena4

1. Ns. Sri Hunun Widiastuti, M.Kep.Sp.Kep.J: Akademi Perawatan RS PGI Cikni

Email: [email protected]

ABSTRACT

The reactions and perceptions of parents towards their children 's influence affect the way they care for and

have an impact on the level of development and self - care of children. The purpose of this study was to

determine the effect of supportive group therapy on the ability of parents to train self care for double blind

children in SLB G Rawinala East Jakarta. The design used in this study was a quasi experiment pre-post test

with control group with 51 respondents, consisting of 26 respondents for the control group. This therapy is

mutual support therapy, given in 4 sessions and carried out for 6 weeks. Parental cognitive, affective and

psychomotor abilities were analyzed using T test, Chi-Square and simple Linear Regression. The results showed

a significant increase in parental ability after being given therapy in the intervention group.

Keywords: parental ability, supportive group therapy, self, care, double blind.

Background

Mental health is something that is needed by

everyone to produce quality human beings

who are free from mental disorders.

According to Stuart & Laraia (2005), mental

health is a state of well-being characterized

by feelings of happiness, balance, feeling

satisfied, self-achievement and optimism.

Law No. 36 of 2009 concerning mental health

states that mental health efforts are intended

to ensure that everyone can enjoy a healthy

mental life, free from fear, pressure and other

disorders that can interfere with mental

health. These efforts consist of preventive,

promotive, curative, rehabilitation of patients

with mental disorders and psychosocial

problems. Every citizen has the right to get

rights in mental health services which include

equality of treatment in every aspect of life in

various settings in the community.

One community order that has the right to

live a healthy life as stated in the Law, is a

family that has children with special needs,

namely families that have children who are

different from normal children in mental

characteristics, sensory abilities,

communication skills, social behavior or

physical characteristics (Kirk and Gallagher,

1986). Wiliam (in Hallahan & Kauffman,

2006) states that children with special needs

mailto:[email protected]

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are divided into 9 categories, one of which is

severe disabilities which in Indonesian is

called tunamajemuk or tunaganda.

Based on the National Census data (Susenas)

in 2003, people with multiple disabilities

according to the type of disability and types

of regions, rural and urban, were 5.64%.

Persons with multiple disabilities according

to the type and causes of disability are as

follows, congenital birth 57.47%, accidents /

natural disasters / riots 16.13% and because

the largest percentage of causes of disability

is congenital birth, the psychological burden

caused by the presence of children should be

anticipated.

Mangunsong, et al. (1998) defines a disabled

child as a child who has a combination or

combination of two or more physical or

mental disorders or disabilities that require

educational, psychological, medical, social

and vocational services to exceed the

services usually available to children with a

single disability. intended so that children

can develop their abilities optimally as

optimal as possible.

In connection with this research, tunaganda

is more focused on multiple disabilities and

visual impairment (MDVI) or as other

double-blind people, ie someone who has

"limitations" physically, sensory, mentally or

is a combination of their lack of vision,

compared to those who have development

and also normal education (Tilstone et al,

2004).

Families that have children with special

needs, including double-blind children, are

also a community mental health problem.

Parents and all family members tend to react

negatively, such as being shocked, denying,

angry, embarrassed, feeling worthless,

disappointed, sad, grieving, etc. (Zelalem,

2002). The reaction arises because the

response from "loss" of the expectation of the

birth of a baby is normal and the reality is not

the case.

Reactions that arise for the presence of

children with special needs, (Blacher, 2002)

divides it into three stages. First, parents are

said to experience a period of emotional

crisis characterized by shock of regret and

distrust. In the second stage, this reaction is

followed by a period of emotional

irregularities which includes changes in

feelings from anger, guilt, depression,

shame, low self-esteem, rejection of children

and excessive participation. In the third stage

is the stage where they begin to accept their

child. This is the phase of loss.

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This can be understood, because the

condition of children with dual blindness has

several characteristics that require more

attention, among others, the average of them

is slow to learn new skills, difficulties in

applying and maintaining new skills learned,

communication difficulties, physical and

motoric development disorders, ability of

independent care (self care) and repetitive

behavior that is not appropriate (Heward,

1996).

All reactions experienced by parents have an

impact on all children's development. This

happens reciprocally, children experience

developmental delays because parents, are

still in reaction to emotional crises and

emotional irregularities. Parents continue to

be in that position, because they tend to think

that their children will not be able to develop.

According to Warren and Trachtenberg,

(1987, in Zelalem, 2002), perceptions of

parents of their child's special needs

influence how to care for and care for their

children.

Although double blind children have all their

limitations and characteristics, they still need

learning opportunities. Every child, both

"normal" and has special needs, should have

equal opportunities in education and teaching

(Carolina, 2006), even the involvement of

parents becomes greater in education for

their children. This shows that parents play

an important role in the process of growth

and development of their children, especially

in children's independence for daily activities

and self care (Miles% Rigio, 1999).

Keterlibatan orangtua dalam membelajarkan

dan The involvement of parents in teaching

and training their children can be enhanced

by the provision of psychotherapy. Some

psychotherapy that can be given to families

is the Psychotherapy group, the Education

Group, Self Help Group (Videbeck, 2006),

supportive groups (Rockland, 1993 in Stuart,

2005; Teschinsky, 2000 in Videbeck, 2006),

and Multiple Family Therapy (Anderson , et

al., 1986 in Bedell et al., 1997). From a

variety of psychotherapy that are useful in

optimizing family empowerment in training

the self-care abilities of multiple blind

children, supportive groups are an alternative

therapy option aimed at improving the

family's ability to be a support system.

Supportive Group is an organized therapy to

help members exchange experiences on

certain problems in order to improve their

coping. Supportive Group is aimed at

reducing family burden and increasing

family coping and increasing social support

(Fadden, 1998, Witux, et al., 2000 in Chien

et al., 2006).

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General Purpose: It can be obtained an

overview of the Effects of Group Supportive

Therapy on Family Ability to Train "Self

Care" for Children with Dual Blindness

Research Methods

This study was a quasi experimental study

with a quantitative method using the design

of "Quasi experimental prspost test control

group" with supportive therapy intervention

groups on May 23 to June 10, 2010. The

sampling technique was Concecutive

sampling. The study was conducted to

analyze the improvement of the family's

ability to train child care in comparing

groups who got and who did not receive

supportive group therapy. Respondents

numbered 51 people. The statistical test used

was univariate and bivariate with dependent

analysis and independent sample t-test and

Chi-Square and simple linear regression with

display in the form of tables and frequency

distributions.

Result

The study was conducted at the Bakti Luhur

Jakarta SLB school, of 51 respondents, 26

respondents who received supportive group

therapy and 25 respondents who did not

receive supportive group therapy, the results

of the analysis were as follows:

a. The results of the analysis of family

characteristics showed that a total of 51

parents were included in this study with

an average age of 40.27 years with the

youngest age of 18 years and the oldest

57 years, the most family education was

secondary education (graduating junior

high and high school) 74.3% the family

is working at 83.8% and the level of

family income shows that the largest

proportion of families shows that the

largest proportion is families with

income of more than 1 million, 87.6%

and under 1 million at 12.2%. The most

family relationships with

children are biological parents of 78.4%.

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Table 1. Analysis of Group Equality Before Supportive Groups are given

Table 2. Family Ability Analysis in both groups before supportive group therapy

Table 3 Family Capability Analysis before and after therapy for supportive groups

in both groups

Ability Group N Mean SD SE T P Value

Cognitive

(pre Test)

Intervention 26 20,42 1,629 0,139 1,563 0,127

Control 25 19,24 3,431 0,686

Affective

(pre test)

Intervention 26 52,46 3,361 0,659 1,975 0,555

Control 25 50,08 5,049 1,010

Psychomoto

r (Pre test)

Intervention 26 21,69 5,555 1,089 1,059 0,226

Control 25 26,36 3,377 0,675

Group N Mean SD Median Min-Maks 95% CI

Intervention 26 20,42 1,629 21,00 16-23 19,77-21,08

Control 25 19,24 3,431 20,00 6-23 17,82-20,66

Intervention 26 52,46 3,361 53,00 46-59 51,10-53,82

Control 25 50,08 5,049 50,00 41-Be59 48,00-52,16

Intervention 26 21,69 5,555 23,50 9-29 19,45-23,94

Control 25 26,36 3,377 28,00 19-30 24,97-27,75

Ability n Mean SD SE T P-Value

Cognitive

Pre Test 26 20,42 1,629 0,319 -2,403 0,024

Post Test 26 21,62 2,228 0,437

Difference 1,20 0,599 0,118

Affective

Pre Test 26 52,46 3,361 0,6059 -5,318 0,000

Post Test 26 58,31 4,662 0,914

Difference 5,85 1,302 0,255

Psychomotor

Pre Test 26 21,69 5,555 1,089 -5,590 0,000

Post Test 26 26,69 4,269 0,837

Difference 5,00 1,286 0,252

Cognitive

Pre Test 25 19,24 3,431 0,686 2,000 0,057

Post Test 25 19,04 3,446 0,689

Difference -0,20 0,015 0,003

Affective

Pre Test 25 50,08 5,049 1,010 -1,365 0,185

Post Test 25 50,20 5,066 1,013

Difference 0,12 0,017 0,003

Psychomotor

Pre Test 25 26,36 3,377 0,675 1,693 0,103

Post Test 25 26,20 3,317 0,663

Difference -0,16 0,060 0,012

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b. Equality Test Results of family

characteristics, namely age by using

independent T-Test and family relations,

education, work and income between the

intervention group and the control group,

using the Chi-Square test were equivalent

(p-value> 0.05). In table 1 shows the

equality of family abilities in the

intervention group and the control group.

The following is the result of an analysis of

the family's ability to train self-care of

children before supportive group therapy

shows an average (1) average cognitive

ability of 19.83, standard deviation of 2.025,

minimum score of 6 and maximum value of

23, (2) Affective ability is 51.23 standard

deviation 4.205, minimum value is 41 and

maximum value is 59. For the average

psychomotor ability is 24.03, standard

deviation is 4.47, minimum value is 9 and

maximum value is 30. Minimum value for

cognitive ability is 0 and a maximum value of

23 while the minimum value of affective

ability is 17 and the maximum value is 68, and

for psychomotor abilities the minimum value

is 0 and the maximum value is 30. Results can

be seen in table 2.

The ability of the family to practice self care

for blind blind children, in groups that

received TKS and family groups that did not

receive TKS, before and after TKS was

tested, using dependent paired T-tests, the

results are presented in table 3.

The results of the analysis in Table 3 show

that before and after giving TKS, family

groups that received TKS had a significant

increase in cognitive, affective, and

psychomotor abilities in training self care for

blind blind children. On cognitive abilities

increased significantly by 1.2 with p = 0.024

(ὰ = 0.005). This increase has shown the

average score of cognitive abilities to be

included in the good category (minimum

score of good category = 15.5). Affective

ability also increased significantly by 5.85

with p = 0.000 (ὰ = 0.05). This increase has

shown that the average score of affective

ability is included in the good category

(minimum score of good category = 46.5).

Significant improvement also occurred in

psychomotor abilities which was equal to

5.00 with p = 0,000 (ὰ = 0.05). This increase

has also made the average score of

psychomotor abilities reach the minimum

limit of good categories (minimum score of

good category = 20.5). The results of the

statistical test can be concluded that at alpha

5%, before and after the TKS, there was a

significant increase in the average cognitive,

affective, and psychomotor abilities in the

7


family group who received TKS in training

self care for blind blind children (p < ὰ 0.05)

Family cognitive and psychomotor abilities

in training self care for blind blind children

before and after, in a family group that did

not get TKS occurred a decrease. Cognitive

abilities fell by -0.16 with a decrease of -0.2

with p = 0.057 (ὰ = 0.05). Psychomotor

ability has decreased by -0.16 with p = 0.103

(ὰ = 0.05) while the affective ability of the

family in training self care for children with

dual blindness, before and after, has a

nonsignificant increase of 0.12 with p =

0.185 ( ὰ = 0.05) is the same as (p-value>

0.05). The results of the statistical test can be

concluded that at alpha 5% there was a non-

significant increase in family cognitive

abilities in training self care for double blind

children in the group who did not receive

TKS before post-TKS (P <5 0.05) but there

was a decrease in cognitive abilities and

family psychomotor with (p> ὰ 0.05).


that the difference in increase in cognitive,

affective and psychomotor abilities in the

family group who received TKS was

significantly higher compared to the family

group who did not get TKS (P <5 0.05).

The difference in the ability of the family to

train self-care for dual blind children in the

family group who did not receive TKS was

carried out using the independent T-Test. The

results of the analysis are presented in the

following table 5.10:

Table 4 Analysis of family abilities in

ATG Self Care training after supportive

group therapy in both groups Group N Mean SD SE T P-Value

Intervention 26 21,61 2,228 0,437 3,158 0,003

control 25 19,04 4,336 0,689

Difference 4,21 0,447

Intervention 26 58,31 4,663 0,94 5,940 0,000

control 25 50,20 5,066 1,013


Intervention 26 26,69 4,269 1,026 3,287 0,006

control 25 26,20 3,317 0,837



that there are significantly higher differences

in cognitive, affective, and psychomotor

abilities, in families who received TKS

compared to family groups that did not get

TKS (p <5 0.05), that is, respectively (0.003

; 0,000; 0,006).

Social support given to families through

supportive group therapy, is one of the

interventions to increase the potential of

parents as a source of coping for individuals

and main teachers, for children with special

needs (Miles & Regio, 1999). The family is

the biggest source of development for

children, related to the role of parents to

empower children to do selfcare.

Factors that contribute to the ability of the

family to train self care for blind blind

children, including age, education,

employment, income and family relations

8


and supportive group therapy, were analyzed

using a simple linear regression correlation

test.

The results of the analysis are obtained as

follows: a. the contribution to the cognitive

ability of the family in training self care for

children with multiple visual impairments

shows that there is no contribution to family

characteristics with (p> ὰ 0.05). Obtained the

coefficient of determination (R square) of

0.285, this means that the variable TKS has

the opportunity to increase cognitive abilities

by 28.5% while the rest by other factors.

As for family affective abilities, results were

obtained: there were no family characteristics

(age, occupation, income and family

relations) that contributed to the affective

ability of the family in training self care for

blind blind children, with (p> ὰ 0.05) except

education (p < ὰ 0.05). The coefficient of

determination (R square) is 0.585, this means

that the TKS variable has the opportunity to

increase affective abilities by 58.8% while

the rest is by other factors.

For psychomotor abilities, it shows that there

are no family characteristics (age of family

relationship, education, employment, and

income) that contribute to the family's

psychomotor abilities in training self care for

children with multiple visual impairments

(p> 5 0.05). The value of the coefficient of

determination (R square) is 0.459, this means

that the TKS variable has the opportunity to

increase psychomotor abilities by 45.9%

while the rest is by other factors.

Based on the results of the above analysis it

can be concluded as follows, that supportive

group therapy can be an alternative to

overcome the difficulties of parents in caring

for and training children. Family

characteristic factors, do not affect the ability

of the family to train children, this is in line

with the opinion of Fontaine (2003), that the

main characteristic of the ability of families

to care for their children is the ability to

produce productive stress. This means that

families need psychosocial ventilation

(psychological burden) in training their

children, so parents need to gather with other

parents who have the same child (Mitchel &

Brown, 1991).

According to Seligman & Darling (1997), the

ability of parents to educate, teach and

collaborate with professional staff is strongly

influenced at the stage of parent's denial of

their children with special needs. Warren and

Trachtenberg, 1987 (in Zelalem, 2002),

emphasize that perceptions of parents on

their children's specific needs influence how

9


to care for and care for their children. This is

because the delay in the development of the

child or the independence of the child in

doing self care is determined by the stage of

parent's acceptance of the child.

(Through supportive group therapy, parents

learn from each other together, share

experiences, situations and problems so as to

reduce the psychological burden and improve

individual coping skills to complete

unpleasant experiences, ignorance of

confusion and stressful situations from each

member's condition (Grant Iramu, 1997 in

Hunt, 2004).

Based on the above, the researchers argue

that the ability of families to train children is

not determined by family characteristics (not

contributing), but is determined by a sense of

comfort in accepting children's limitations,

which in turn motivates parents to teach

children about self care. Berdasarkan hal

tersebut diatas, peneliti berpendapat bahwa

kemampuan keluarga melatih anak tidak

ditentukan oleh karakteristik keluarga (tidak

berkontribusi), tetapi ditentukan oleh rasa

nyaman menerima keterbatasan anak, yang

selanjutnya memotivasi orangtua untuk

membelajarkan anak dalam hal self care.

Conclusion

a. Family characteristics that have double

blind children on average are 40.3 years

old. The family group that received TSK

averaged 42.54 years old while the family

group that did not receive TSK averaged

38 years.

b. Respondent characteristics for the

intervention group and the control group

and the ability of parents to provide self

care training, before getting group

supportive therapy increased

significantly. In the intervention group.

c. The effect of group supportive therapy on

the ability of parents to provide self care

exercises before and after group

supportive therapy increased

significantly. In the intervention group.

d. The increase in the ability of parents to

provide self care training to parents who

received supportive group therapy was

significantly higher compared to groups

that did not receive supportive group

therapy significantly higher than those

who did not receive supportive group

therapy.

e. Supportive group therapy has the

opportunity to increase cognitive abilities

by 28.5%, and improve affective abilities

by 58.5% and psychomotor abilities by

45.9% after being controlled by other

factors.

10


f. The ability of parents to provide self care

training is not influenced by family

characteristics, namely: age, education,

work, income and family relationships.

Suggestions

Related to the conclusions of the research

results, there are several suggestions,

namely:

a. An organization organization needs to be

established that allows the soul nursing

service area to expand in the world of

education, especially SLB. Follow-up is

coordination between the Ministry of

National Education (Directory of

Special Education) with the Provincial

Health Office through SLB education

institutions and mental nursing.

b. The Ministry of Health of the Republic

of Indonesia sets out a policy to improve

health promotion efforts in health

promotion groups in healthy groups

based on community according to the

mental health issue in the world, namely

community empowerment.

Understanding of community is

understood together as a large, formal

and informal area.c. Organisasi profesi

menetapkan terapi suportif kelompok

sebagai salah satu kompetensi dari

perawat spesialis keperawatan jiwa.

c. Build networks to collaborate with

schools in conducting continuous

training to parents and it is hoped that

this will become a pilot project for

similar schools. It can be started from

school insulated with SLB G Rawinala

and educational institutions of the

Faculty of Nursing.

d. Nursing tertiary education should

develop therapy for healthy groups in

order to improve family capacity in a

variety of social settings, including the

world of education.

e. Evidence based in developing

techniques for the provision of mental

nursing care for all health service

settings in the application of group

supportive therapy for families who have

children with special needs, maybe even

other therapies.

f. The need for further research is carried

out on the wider community, for the use

of other specialist therapies.

g. Further research is needed for the role of

other parents in children with special

needs using the same or different

methodologies.i. Perlu diteliti lebih

lanjut tentang faktor perancu lain,

misalnya usia anak karena ada pendapat

semakin dini usia anak dilatih, semakin

banyak kesempatan mengembangkan

potensinya.

11


h. Need to improve the implementation of

therapy; module or evaluation tool.

i. The instruments that have been carried

out in this study should be used as a

measurement tool and refined for the

same therapy.

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BOyd, M.A., & Nihart, M.A. (1998).

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young children and their families,

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intervensi dini tumbuh kembang

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dasar. Jakarta.

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an introduction to special education

(5th ed). New Jersey: Prenticce Hall.

Hunt. (2004). A Resource kit for self

help/support groups for people affected

by an eating disorder.

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lunteerGuide. Pdf Diperoleh tanggal 6

Maret 2010

Kirk. SA., & Gallagher, J.J. (2007).

Educating exceptional children,

princenton, N.J: Recording for the

Blind & Dyslexic.

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pendidikan anak luar biasa. Depok:

LPSP3 UI

Miles, B., & Rigio, M. (1998). Remakable

conversations. Massachusetts: Perkins Scool

For The Blind

Mitchel, D., & Brown, R.I. (1991). Early

intervention studies for young chidren

with special needs. London: Chamman

and Hall.

Mohr. WK, (2006). Psyhiatric mental health

nursing (6 th edition), Philadelphia,

Liipincott Williams & Wilkins.

Murthy, S.. (2003). Family interventions an

empowerment as an approach to

enchance mental health resources in

developing countries.

www.pubedcentral.nih.gov. Diperoleh

tanggal 11 Februari 2008.

Stuart, G.W & Layton, L., Anderson, A.,

Gerrish, R., Morgan, J., & Williams, A.

(2004). Child development and

teaching pupils with special

http://www.medhelp.org/njggroups/VolunteerGuide

http://www.medhelp.org/njggroups/VolunteerGuide

http://www.pubedcentral.nih.gov/

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educational needs. London & New

York:

Routledge Falmer Taylor& Francis Groups.

Zelalem, F. (2002). The attitudes of

parents towards their blind children : a

case study ini Bahir Dar Town. Addis

Ababa University School of Graduates

Study.

Videbeck, S.L .(2006). Psyhiatric mental

health nursing. (3rd Ed). Philadelphia:

Lippincott Williams& Wilkins.

13


ANALYSIS OF FACTORS AFFECTING YOUNG WOMEN

ATTITUDES TOWARD FEMALE HYGIENE AND PERINEAL

HYGIENE BEHAVIOR

Ira Sukyati

Lecturer AKPER Pasar Rebo Jl. Tanah Merdeka No. 16, 17, 18 Jakarta Timur

E-mail: [email protected]

ABSTRACT

Adolescence is a transition from childhood to adult life, at this time is the beginning of the development of puberty,

where menstruation occurs. Menstruation is considered a natural phenomenon that usually occurs during the

teenage stagewhich starts at the age of 12 years. The problem that is often experienced in this period is teenagers

are often reluctant to discuss menstrual problems with their parents, friend or anyone, this causes disregard for

clean health practices during menstruation.By getting good knowledge and knowing the practices during

menstruation. By getting good knowledge and knowing the practice of maintaining hygiene during menstruation

will avoid the risk of productive tract infections this study aim to analyze the factors that influence attituuted towards

hygiene of the female area and the behavior of performing perineal hygiene during menstruation. This study uses

across sectional research design. The number of respondent in this study uses a cross sectional research design.

The number of respondents in this study were 100 teenagers who have an age range of 17 -20 years who have

experienced menstruation. The results of this study found that maternal work is the factor that most influences

adolescent attitudes toward cleanliness of the female area and the behavior of performing perineal hygiene during

menstruation.This helps teens prevent infection as early as possible and improve reproductive health in the female

reproductive organs.

Keywords: Menstruation, reproductive organ infections, adolescents.

INTRODUCTION

Menstruation thus reflects the start of the

puberty period in women. Young women

who have experienced menstruation

experience different changes that occur in it,

both physically and psychologically. The

problem that is often experienced in this

period is that teenagers are often reluctant to

discuss menstrual problems with their

parents, friends or anyone, this causes

disregard for clean health practices during

menstruation, by getting good knowledge

and knowing practices to maintain

cleanliness during menstruation will avoid

risk of reproductive tract infections

(Logeswari, 2015). According to UNESCO,

(2014) Several factors are needed so that

young women who are just menstruating can

practice their hygiene properly, namely

having accurate knowledge, the availability

of health workers or professional teachers,

the availability of facilities for

environmental hygiene and sanitation such

as the availability of sufficient water and

trash bins to dispose of sanitary pads, the

availability of safe sanitary pads. According

to Sharvanan (2016) in his research stated,

puberty is a challenge for young women to


14


be able to prepare for changes that occur in

the body. In some parts of the world it is

found that adolescents do not know what to

do when menarche occurs, this will have a

negative impact on physical and emotional

development that causes a decrease in self-

esteem, while the physical impact caused in

research conducted by Kanal et al (2016),

adolescents who do not prepare for the

changes that occur, do not know how to do

perineal hygiene properly so that they

experience reproductive tract infections by

2.7%. Therefore. In Turkey, the majority of

teens said that the majority of menstruation

education should be provided by health

professionals (54.4%) compared to families

(30.0%) or teachers (5.9%). Most teenagers

do not have good knowledge about

menstruation (Shah et al. 2013).

Based on a brief description in the

background of the problem above, the

researcher formulated a research question,

namely "What factors most influence the

attitudes of young women towards the

cleanliness of the female area and the

behavior of performing perineal hygiene

during menstruation.

METHOD

The target population of this study are all

teenagers who are part of the student rebo

market, adolescents who have experienced

menstruation. Has an age range of 17-20

years. This study uses several

questionnaires, namely Questionnaire A

containing the characteristics of

respondents. Questionnaire B contains

adolescent knowledge about healthy

menstruation, and questionnaire C about the

behavior of adolescents performing perineal

hygiene during menstruation. This is in

accordance with the objectives in this study

to find out the factors that most influence the

attitudes and behavior of adolescents in

maintaining the cleanliness of the female

area during menstruation. The questionnaire

has been used in research (Prajayanti 2009).

The design in this study is an analytic

descriptive design to evaluate the

characteristics of respondents and conduct

the Kolmogorov-Smirnov test to determine

the normality test of the data. Multivariate

analysis using linear regression is used to

determine the factors that most influence the

occurrence of adolescent attitudes and

behavior in maintaining the cleanliness of

the female area during menstruation.

RESEARCH RESULT

Characteristics of Respondents for

Gynecologic Cancer Survivors

15


Based on table 1 1, this study shows that

respondents have the age category of late

adolescents aged from 18 to 20 years

(100%), have high knowledge (84%), with

menarce age of most early adolescents, 11 to

14 years (98%), most had a regular

menstrual history of 2 to 6 days (79%) and

obtained sources of information related to

menstruation mostly from mothers or sisters

(53%), with most maternal education having

a high education level of 78% and work as

much as 61% as housewives (78.9%), have

higher education (high school - tertiary

institutions) by 60%.

Table 1. Distribution of Characteristics of Teenage Respondents who have received

Menstruation in the Akademi Keperawatan Pasar Rebo in 2018 (n = 100)

Variabel Kategori Frekuensi Persentase (%)

Age Middle Age Teenagers (15-17

years

Late teens (18-20 years)

0

100

0

100

Education Higher Education (SMA-PT) 78 22.0

Low Education 22 78

Employment Works 61 61.0

Housewife 39 39.0

Length Irreguler (> 6 hari) 21 21

menstruation Reguler( < 6 hari) 79 79

Adolescence (15-7 th) 2 2

menarche Intermediate Teenager

(11-14 th)

98 98

Sourches Internal(siblingpr,mother) 47 47

Information External(friend,print

media, teacher)

53 53

knowledge High 84 84

Low 16 16

Based on table 2 above, a bivariate test has

been carried out with the results that there is

a p-value <0.25, namely occupation and

mother's education and age of menarce and

adolescent knowledge.

16


Table 2 Relationship of Respondent Characteristics with Attitudes towards the cleanliness of

femininity in AKPER Pasar Rebo in 2018 (n = 100)

Variabel Mean SD SE P value CI 95%

Employment

Housewife 78.74 5.88 0.94 0.069 -0.14-

3.76

Works 76.93 3.95 0.50 0.096 65.94-

77.69

Education

High 77.91 5.09 0.57 0.297 -1.09-3.55

Low 76.68 3.82 0.81 0.225 -0.78-

3.24

Length Menstruation

Reguler 77.58 5.02 0.56 0.819 -2.65-2.10

Irreguler

77.85 4.28 0.93 0.803 -2.48-1.93

Menarche

Adolescence 1.50 4.84 0.48 0.225

1.31-1.69

Intermediate Teenager 1.37 4.94 0.70 0.438 1.23-1.51

Knowledge

High

Low

76,29

75,75

5,39

5,47

1,34

0,59

0,07

0,08

-2.22-1.63

-4,92-0,27

-4,97-0,32

Based on table 3 after the bivariate test, p-

value <0.25 was not found, so the mother's

work variable was made one of the variables

that could represent variables for the next

stage, namely mother's work, because the p-

value was close to 0.25.

Table 3 Relationship of Respondent Characteristics with perineal hygiene behavior during

menstruation at the Rebo Market AKPER 2018 (n = 100)

Variabel Mean SD SE P value CI 95%

Employment

Housewife 76.89 6.00 0.96 0.315 -1.08-3.34

Works 75.77 5.04 0.64 0.334 -1.18-3.43

Education High 76.19 5.64 0.57 0.603 -2.65-2.10

Low 76.27 4.75 0.81 0.588 -2.48- 1.93

Length Menstruation

Reguler 77.58 5.02 0.56 0.819 -3.35-1.96

Irreguler

77.85 4.28 0.93 0.803 -3.29-1.89

17


Menarche

Early Teens 76.20 5.49 0.55 0.940

-8.04-7.44

Intermediate

Knowledge

High

Low

76.50

75,75

76,29

0.70

5.39

5.47

0.50

1,34

0,59

0.709

0,71

0,71

-2.22-1.63

-3,50-2,41

-3,61-2,51

Table 4 Results of the Characteristics of Respondents Selection of with Attitudes towards the

cleanliness of the female area and the behavior of perineal hygiene during menstruation in

AKPER Pasar Rebo (2018).

Variable attitude Behaviour

p- valeu p-value

Employment

Housewife 0.069 0.315

Works 0.096 0.334

Education

High

Low

0.297

0.225

Menarche

Early Teens 0.225

Middle 0.438

Pengetahuan

Tinggi 0,07

Rendah 0.08

In table 4 shows the variables that may be included in multivariate modeling.

Tabel 5.5 Pemodelan Multivariat Sikap Remaja

Model Coefficients B P value ( R2) R

Model 1

constant 70,59 0.09 0,302

Employment

Age of Menarche

1,9

5,3

0.05

0.13

Resources

Knowledge

-1.0

2,0

0.25

0,13

Model 2

constant 70,59 0.078 0,280

Age of Menarche 4,7 0.17

Mother’s Job

Knowledge

1,9

1,9

0.05

0,14

Model 3 0,245

18


Model Coefficients B P value ( R2) R

constant 75,15 0.06

Employment

Knowledge

1.69

2,16

0.08

0,09

Model 4

Constant

Employment

76,93

1,80

0,06

0,33

0,183

DISCUSSION

In this study shows that the average

respondent most of them are those who have

the age category of late adolescents aged

from 18 to 20 years, have high knowledge

(84%), with the age of menarce most of the

early teens namely 11 to 14 years ( 98%),

most had a regular menstrual history of 2 to

6 days (79%) and obtained sources of

information related to menstruation mostly

from mothers or sisters (53%), with most

maternal education having a high education

level of 78% and work as much as 61% as

housewives (78.9%), have higher education

(high school - tertiary institutions) by 60%.

The results of this study are in line with the

results of research conducted by Susanti et

al (2015), which is obtained that the

frequency distribution of respondents'

knowledge which is the most

knowledgeable is around 52.9%. The results

of research that has been done suryati

(2012), namely the characteristics of

mother's education have higher education

mostly 66.7%, most mothers work not

working, most respondents have high

knowledge 53.2%. According to Yanti, et al

(2014), it was found that there were

characteristics of respondents that most of

them had a high level of knowledge about

menstruation by 57.1% and the majority of

respondents aged 16 years were 47.1%.

While based on research conducted by

Novitasari, et al (2014). Most have good

knowledge about menstruation, while the

majority of information sources are obtained

from parents.

The three studies are based on the

characteristics of young women respondents

in the above studies that have a match in the

level of knowledge, it is because most of the

respondents were high school educated so

that the information obtained is the same.

Sources of information can stimulate

knowledge about menstruation, but in

receiving information respondents have

different perceptions so that it will affect the

level of knowledge that only merely knows,

understands or has a wrong perception. So

19


even though information has been freely

accessed, but whether or not knowledge

depends on each individual in attention,

understanding and discovery of information

received. (sermon 2014). Based on the

above research, respondents are in the

category of middle to late adolescents,

which means that the increase in

respondents' knowledge is also influenced

by age, the more age the better the ability to

catch and think patterns of a person so that

the knowledge gained is getting better. The

biggest source of information is obtained

from parents. Communication between

parents, especially mothers and children is

at risk of providing information that is better

understood by children so that it will be able

to increase children's knowledge.

Factors that Most Influence adolescent

attitudes towards cleanliness of the

female area and behavior of perineal

hygiene during menstruation.

The results of this study can be found that

maternal work is the most influencing factor

in adolescent attitudes towards cleanliness

of the female area and the behavior of

perineal hygiene during menstruation. The

results of this study are in line with

Purnamasari and Notobroto (2015), that

there are 75% of respondents working

women who have an impact on the source of

information received related to good

attitudes and behaviors towards the

cleanliness of the female area when

menstruation increases. Support information

provided to young women includes what is

meant by menstruation, how to practice

hygiene behavior during menstruation so

that the support provided will foster

adolescent self-confidence because of the

changes that occur and help prevent health

problems during menstruation (Sommer et

al., 2015). Other studies that are in line are,

according to Mandasari, (2009) found that

most respondents in this study are working

mothers who have an impact that

adolescents have a good role because there

is more information about menstruation,

because working mothers tend to be easier

to get access better for various information

including health. According to Sooki et.al

(2016), mothers are the most recent source

of information about the menstrual process

by 60%.

In principle, the role of mothers in preparing

teenagers with menstruation and various

problems is very important. The role of the

mother includes as educators, drivers, role

models, supervisors, friends, inspiration,

counselors and communicators. The role of

the mother is very important in the process

of growth and development of children,

20


especially during adolescence, if the mother

does not have adequate sources of

information about menstruation, it may

cause health and welfare problems such as

infections in the reproductive tract.

Research Limitations

Respondents' backgrounds that have the

same thing are teenagers who are continuing

their studies at AKPER Pasar Rebo so that

they do not have different respondent

characteristics and this results in research

results that are very difficult to generalize

elsewhere.

6.3 Implications of Research Results

The results of this study have implications

for nursing services, especially maternity

nursing, namely the need for training in

mothers about preparing teenagers at

puberty (especially with regard to

menstruation). Puberty in adolescence is the

most important period. Puberty causes

physiological, biological and psychological

changes and this period is very important to

improve reproductive health, so that there is

no disruption by planning the training of

mothers who have young women by

involving groups in the community,

religious groups can make the first step in

health services for improve adolescent

reproductive health (Naghshineh, 2017).

This helps teens reduce PMS (premenstrual

syndrome) and prevent infections and

improve adolescent reproductive health.

BIBLIOGRAPHY

BKKBN. (2012). Survei demografi dan

kesehatan Indonesia 2012: Kesehatan

Reproduksi Remaja. Jakarta:

BKKBN.

Dahlan,Sopiyudin,2014. Statistik Untuk

Kedokteran Dan Kesehatan Edisi 6.

Jakarta, Salemba Medika.

Kansal S, Singh S, Kumar A. (2016).

Menstrual Hygiene Practices in

Context of Schooling: A Community

Study Among Rural Adolescent Girls

in Varanasi. Indian J Community

Med.

Khotimah, dkk (2014). Pengetahuan Remaja

putri tentang Menstruasi dengan sikap

menghadapi Dismenore kelas XI di

SMA Muhammadiyah 7, Yogyakarta.

Journal Ners And Midwifery

Indonesia.

Logeswari. (2015). The Effect Of School

Based Health Education Regarding

Menstrual Hygiene An Intervention

Study Among Adolescent Girls Of

Perambalur District. Dissertation.

Mandasari dan Anjarwati (2009). Gambaran

Peran ibu Dalam mempersiapkan

Menarche pada Siswi MTs

Muhammadiyah 2 Muntilan

Kabupaten Magelang Jawa Tengah.

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Karya Tulis Ilmiah tidak

dipublikasikan.

Naghshineh, et al. (2017). Knowledge of

Mothers about Puberty Health In Gils

: A Survey In the Center Of Iran.

International Journal Of Travel

Medicine and Global Health. 2017;

5(3); 102-106

Putri R.H (2016). Hubungan Antara

Kebutuhan pelayanan Suportif

Dengan Kualitas Hidup Pasien

Kanker Ginekologi Yang menjalani

Terapi. Universitas Indonesia

Potter, P & Perry, A. (2005). Buku Ajar

Fundamental Keperawatan : Konsep,

Proses dan Praktik. Edisi 4. Jakarata :

EGC.

Purnamasari dan Notobroto (2015).

Dukungan Informasi tentang

Menstruasi kepada Anak Usia

Sekolah Dasar. Jurnal Biometrika dan

kependudukan, Vol. 4, No. 2 Desember 2015:

181–190

Rahmatika, (2010). Pengaruh Pengetahuan

Dan Menstruasi Sikap Tentang

Personal Hygiene Menstruasi

Terhadap Tindakan Personal Hygiene

Remaja Puteri Pada Saat Menstruasi

Di SMK Negeri. Skripsi. Tidak

dipublikasikan

Shah SP, Nair R, Shah PP, Modi DK, Desai

SA, Desai L (2013) Improving quality

of life with new menstrual

hygiene practices among adolescent

tribal girls in rural Gujarat, India.

Reprod Health Matters 21:205–213.

https://doi.org/10.1016/s0968-

8080 (13)41691-9

Sriniva. (2017). Menstrual Hygiene Among

School Going Adolescent Girls.

International Journal of General

Pediatric and Medicine.

Suryati. (2012). Perilaku Kebersihan

Remaja Saat Menstruasi. Jurnal

Health Quality Vol.3.

Stuart,G.W. (2013). Psyciatric Nursing.

(Edisi 10). Jakarta: EGC

Vashrani. (2013). A Study On Menstruation

And Personal Hygiene Among

Adolescent Girls Of Government

Medical College, Solapur. National

Journal Of Community Medicine.

Volume 4.

William. (2012). Menstrual Disorder In

Adolescents: Review of Current

Practice.Mini Review, Hormone

Research In Pediatrics.

https://doi.org/10.1016/s0968-

22


EVALUATION OF NURSE PROFESSION EDUCATION PROGRAM IN

STIKES PEKANBARU

Ennimay

Ennimay, S.Kp., M.Kes : Universitas Negeri Jakarta ; STIKes Hang Tuah Pekanbaru

E-mail : [email protected] ; [email protected]

ABSTRACT

Introduction: Professional nursing personnel are needed to meet the demands of the community for nursing care

services. Health colleges are required to be able to produce competent medical graduates. This study aims to

evaluate the implementation of Nurse professional education programs at Pekanbaru STIKes. Method: This study

used a research design evaluation model Context, Input, Process, Product. The partisipant were 16 person which

taken by purposive sampling. Data collecting used focused group discussion and in depth-interview. Data analyze

used data comparison with evaluation criteria. Results: Nurse professional education goals and planning have been

made according to Nurse professional education curriculum and has been carried out in accordance with the

regulations. The implementation was used the preceptorship model. Otherwise, Nurse graduates who pass the

competency test nationally are still below 100%. Conclusion there were still obstacles in the guidance process on

practical setting. Recomendation: improvements were needed in the guidance process.

Keywords: Evaluation program, education, nurse profession, preceptor, competency test

INTRODUCTION

The amount of public demand for quality

health services requires professional nursing

staff to produce competent and professional

nurse graduates, each college is required to

be able to produce graduates who are in

accordance with market needs, one of which

is curriculum development. Research

(Zapko, Ferranto, Blasiman, & Shelestak,

2018) concluded that with serial simulations

and obtaining simulation experience more

than once in a row are methods that valuable

for clinical instruction. If implemented

properly, simulations can improve student

satisfaction and confidence. Research

(Zieber & Sedgewick, 2018) on

Competence, confidence and memory recall

in nursing students using a mixed method

research design states that interventions are

effective in enhancing both their perceptions

of competence and confidence immediately

within a period of three months, the memory

capacity of knowledge also statistically

significant over a period of three months.

Nurses as a profession that carries out

nursing care and practice, with the

qualifications required to have a Registration

Certificate (STR) as written evidence and

official records issued by the Indonesian

Health Personnel Council (MTKI). Based on

the data obtained from the 4 STIKes in

Pekanbaru, it can be concluded that from a

total of 589 competency test participants



23


from 2014 to 2017 it was found that the

average graduation rate = 57.3%, and those

who did not graduate = 42.7%. This shows

that the graduation results are still low.

Where the number of students who do not

pass is quite high and can cause high

unemployment due to not having a

competency test certificate which is a

requirement to obtain a nurse registration

certificate (STR). The high rate of disability

is closely related to the performance of the

learning system and the quality of graduates.

Many participants competed in the National

Professional Education Program competency

test and especially in Pekanbaru who were

incompetent, namely the passing of

competency test participants as much as

57%. So it is still questionable how the

quality of graduate nurses in Indonesia and

the implementation of the Nurse Professional

Education Program at STIKes in Pekanbaru

city.

Competency test is the process of measuring

the knowledge, skills and behavior of

students in universities that hold higher

education in health in accordance with the

Minister of Education and Culture

Regulation Number 12 of 2016 concerning

Procedures for Implementing Competency

Test for Health Sector Students, Ministry of

Research, Technology and Higher Education

(Kemenristekdikti, 2017). According to

(HTP, 2017) the implementation is carried

out by the Organizing Committee

determined through the Decree of the

Minister of Research, Technology and

Higher Education. This exam is intended to

achieve competency standards of graduates

who meet work competency standards and

the National Competency Test can be used as

part of educational quality assurance. health

in Indonesia. So from that starting in 2014,

2015, 2016 and 2017 there have been four

consecutive years of professional

proficiency test with CBT (Computer Based

Test) system.

The research conducted by (Kholifa &

Kusumawati, 2016) on Nurse graduate

students who took the competency test found

that the obstacle of graduates in facing

competency tests was due to confusion and

lack of clinical experience, increased

anxiety, hesitation when answering

questions and problematic computer mouse

used. answering questions, this resulted in

many Nurse students not passing the

competency test. Research (Abdillah, 2016)

said there was a relationship between try out,

GPA, learning style and the value/

graduation rate of Indonesian nurse

competency test results. This study aims to

evaluate the implementation of professional

education programs for nurses in

Pekanbaru's STIKes. Novelty in this study

24


with the CIPP evaluation model has never

been done in Indonesia.

METHOD

The study used a CIPP evaluation model

design Context, Input, Process, Product

(CIPP) in Pekanbaru STIKes. The object of

evaluation is the Professional Nurse

Education Program with subjects includes

clinical preceptors, academic preceptors,

nurse graduates. The research instrument in

this study used guidelines for in-depth

interviews, questionnaires and Focus Group

Discussion (FGD). Where the instruments

made refer to the CIPP model which

includes context, input, process, and product

and outcome to assess the evaluation of

professional education programs in

Pekanbaru STIKes. The technique of data

analysis used data comparative by

evaluation criteria. This research was passed

the ethical clearance reviewed by Ethical

Committee of STIKes Hang Tuah

Pekanbaru.

RESULT

The results of the study Evaluation of the

Nurse Profession Education Program in

Pekanbaru STIKes using the CIPP Model

(Contexs, Inputs, Process Products) with the

object of research is the Nurse professional

education program in Pekanbaru. There were

four STIKes which were the subjects of the

study, namely HTP STIKes, PN STIKes, AI

STIKes and PMC STIKes.

1. Context Evaluation Results

Sub-focus 1. Objectives of competent

professional Nurse education programs

The context evaluation results focus on

how to achieve the goals of the Nurse

professional education program related

to the rules underlying the

implementation of education, curriculum

standards used, the process of preparing

for the implementation of educational

programs and processes in setting

educational goals. The program

objectives of each institution are made

according to the needs of nursing

services where each institution describes

them in accordance with the Tri Dharma

of higher education and as a guide in

making Nurse education curriculum. The

regulations that underlie the

implementation of educational programs

and curriculum standards used are

curriculums set by the DIKTI (Director

General of Higher Education) and the

Association of Indonesian Nurse

Education Institutions (AIPNI). The four

institutions use the same national

standards in designing the making of the

Nurse professional education

curriculum. The curriculum used is a

25


curriculum that was established by

AIPNI in 2009 which was later updated

to become the 2014 National

Qualifications Framework (KKNI)

curriculum which was approved by the

DIKTI in 2015 and applied in the 2016

school year.

2. Input Evaluation Results

Sub-focus 2: Planning of the Nurse

professional education program

learning system at Pekanbaru STIKes

Input evaluation aims to find out the

planning of the Nurse professional

education program learning system. The

evaluation results obtained were that the

four institutions had formulated a

learning system plan on the part of the

study program. The plan was submitted

to the foundation and the study program

could only carry out the learning process

after obtaining approval from the

foundation. All institutions involved in

this research are private institutions

under the auspices of the foundation. In

order to meet the resource requirements

in conducting professional education for

Nurse, the profession coordinator will

appoint a course coordinator who is

responsible for the implementation of

professional practice, the course

coordinator appoints academic

preceptors who are in accordance with

their scientific fields. The clinic

preceptor is appointed by the hospital

management with a decree from the

Director with minimum criteria is Nurse

education level and have a minimum of

two years work experience and have a

preceptors certificate.

Learning system planning is made

referring to the availability of resources,

starting from the number of students who

re-register, then the study program

makes proposals about the funding

needed for the operation of educational

programs submitted to the foundation.

The profession coordinator with the team

designed the Clinical practice setting

where students practice and make MoUs

with the clinical praactice institutions,

according to the guidelines of

professional practice.

Academic and clinical preceptors

collaborate in guiding students by

dividing the guidance schedule within 1

week 3 days of academic preseptors and

3 days of clinical preseptors because

there are still limited resources of

lecturers. Academic preceptors

education for at least magister nursing

and clinical preceptors is minimum

Nurse profession (bachelor degree) with

a minimum of 2 years experience).

26


The recruitment process of professional

education program students is students

who have completed their undergraduate

in bachelor degree nursing education,

coming from their own institutions but

two of the participants stated that the

institution accepts students from outside.

Students register again, then students are

registered again at Ministry of Research

and Technology in Higher Education to

obtain the Student Identification Number

(New NIM. Requirements must be

undergraduate nursing. Students make

statements following the profession for 1

year.

Each institution has an organizational

structure and the majority of its

organizational structure forms are line

and functional organizational structures.

This can be seen from the structure of the

study program chairman, secretary,

treasurer, coordinator of professional

education programs nurses, subject

coordinators and preceptors.

The profession coordinator made a

proposal to prepare the budget needed in

the implementation of the professional

education process. The resource of

budget comes from students and approve

to the foundation through the chair of

STIKes. The head of the study

program/profession coordinator appoints

the course coordinator, the profession

coordinator with the team to design

where the practice land is, which MoU

will be developed, determine the

schedule, and make the budget plan. The

clinical practice of the Nurse profession

refers to the guidance of the Nurse

profession clinical practice that has been

made by each institution, then prepares

for its implementation. Institutional

support is given by giving permission to

all Nurse education institutions in

Pekanbaru to carry out professional

practice by making an MoU between

educational institutions and the clinisal

practice institutions.

3. Results of Process Evaluation

Sub-focus 3. Implementation of Nurse

professional education learning

program at STIKes Pekanbaru.

The implementation of the Nurse

professional education program is in

accordance with the guidelines of

professional practice made by each

institution with the collaboration

between the academic preseptor and the

clinical preseptor regarding learning

outcomes to obtain student competency.

Academic preceptors and clinical

preseptors collaborate on clinical

practice in the guidance process, related

to the achievement of learning to be

achieved when students practice. Before

students begin to practice a perception

27


equation between academic and clinical

preceptors is held, when the perception

equation has been prepared a guidebook

related to the schedule and activities to be

carried out, as well as the standard of

assessment. But at the time of the same

perception when there is input from the

clinical practice related to the results of

the previous evaluation, we will make

improvements. Students prior to going to

the ward held orientation and

socialization about infection prevention

and control in the ward.

In the guidance process, it was found a

problem where the academic preseptor

could not come to guide according to an

agreed schedule and the clinical

preseptor could not guide students

because of his busy life as head of the

ward and team leader. To find out the

results of student competency

achievement during the practice of Nurse

profession at the end of the stase,

students will be evaluated. The form of

evaluation that has been carried out by

the four institutions focuses on the ability

of students to carry out nursing care for a

case. The evaluation methods carried out

included the Direct Observational

Procedural Skill Test (DOPS), Student

Oral Case Analysis (SOCA), managed

case reports, mini seminars and

counseling presentations. In addition to

cognitive and psychomotor aspects, the

assessment also includes affective

aspects, where students' soft skills while

practicing nurses in the room are also

assessed by preceptors, both clinical

presidents and academic preceptors.

After the guiding process of clinical

preceptors and academic presidents

conducts evaluations of student

competency achievements at the end of

the stase before students move rooms by

holding DOPS examinations, case

seminars, health education, to get

feedback on student learning outcomes.

If students fail to be given the

opportunity to repeat by looking for their

own cases. The final assessment is given

according to the criteria that have a

percentage in the practice manual. If

there is a failure, students are given the

opportunity to repeat until their

competence is achieved. Then each

clinical preceptor will submit an

evaluation and give the evaluation report

of each student at the end of the stase to

the profession coordinator in accordance

with the evaluation format in the practice

manual for the Nurse profession.

Complaints from students also have

academic presidents who have never

come to guide the hospital. The

expectations of students to improve their

competencies so that those who become

28


clinical preceptors are nurse

practitioners, for the assessment of

actions taken by students should involve

the nurse practitioners, at the beginning

of the students practice so that academic

preseptors are also in the ward.

4. Results of Product Evaluation

Sub-focus 4. Achieving the results of the

Nurse professional education program

at STIKes Pekanbaru.

Evaluation results conducted by

researchers on professional professors in

Pekanbaru, namely Stikes PN, Stikes

PMC, Stikes HTP, and Stikes AI

conducted by researchers on 589

competency test participants held from

2014 to 2017 found that participants who

passed the test National competence on

average is as much as 57.3%, so there are

42.7% who do not pass the competency

test. This is not in accordance with the

target of graduates who are supposed to

be 100%. The low graduation rate of the

Nurse national competency exam has an

impact on the process of obtaining

registration letters (STR) Nurse which is

a requirement to get a job in a health

service facility because the competency

test certificate is a requirement to obtain

a STR.

5. Outcome Evaluation Results

Sub-focus 5: Impact of Nurse

professional education graduates

Based on the data from the tracer study

obtained from the one of STIKes related

to the length of time to get a job in a

branch less than three months of

graduation, there was an increase from

2014 to 2017. For a 3-12 month waiting

period there was a decrease in the

percentage of graduates. This is because

students have got jobs faster. The data

from the tracer study obtained from the

other STIKes is that the average waiting

time for graduates to work is around

three to four months from 2014-2017.

The majority of graduates from both

institutions work in private institutions.

Based on the results of discussion of

researchers with nursing managers from

well-known private hospitals in the city

of Pekanbaru, there have been several

graduates from one of STIKes who were

trusted as head of the ward and team of

managers, and some were sent to follow

advanced skills training, such as

hemodialysis nursing training, ICU,

emergency, this is given as a reward for

their achievements during work. In

addition, the nursing manager also stated

that he was happy to receive graduates

from one of STIKes because they had

better ethics, while skills could be honed

29


according to the length of work

experience. Not all Nurse graduates work

in Pekanbaru, some graduates return to

work in regencies that are spread in Riau

Province.

DISCUSSION

1. Context Aspects (Context)

Sub-focus 1. Objectives of professional

education programs Nurse: Nurse

professional graduates who are

competent.

The results of the evaluation and analysis

on the aspect of the context, it was found

that the basis for the implementation of

educational programs and curriculum

standards used was the curriculum

established by DIKTI and AIPNI. Each

institution has its own characteristics in

accordance with the university's vision

and mission. Institutional curriculum

development has followed the rules of

competency-based curriculum design

and curriculum referring to the AIPNI

and KKNI.

The program's objectives are in

accordance with Minister of Research

and Technology of Higher Education

Regulation No. 44 of 2015 concerning

the National Standards for Higher

Education and Minister of Research and

Technology of Higher Education

Regulation No. 12 of 2016 concerning

procedures for implementing

competency tests for health sector

students. Relevance to the target, where

the goal is to produce graduates with

GPA ≥ 3 and get a professional

certificate when graduating, this is in

accordance with the Minister of Research

and Technology Regulation No. 44 of

2015 article 5. The duration of study for

professional programs is one to two years

after completing the undergraduate

program, this is in accordance with the

curriculum guidelines referring to the

2014 AIPNI KKNI. The other target

clarity is that professional graduates must

be able to obtain competency certificates.

The process of formulating professional

education objectives involves several

parties, including Nurse practitioners

who also act as stakeholders, foundations

and experts. The goal is to involve

stakeholders as well as evaluate

programs that have been implemented

previously, provide input for program

improvement and also know the needs of

the field. The five principles in setting

effective goals according to Locke and

Latham's in (Pawar, 2017) are the clarity

of goals must be specific and clear,

challenging, easy and boring goals are

demotivating but maintaining a realistic

balance, do not expect everyone in the

team to achieve goals (to spin straw into

30


gold), commitment: your employees

must understand and buy goals from the

set, provide feedback through the entire

process. this helps to keep the goals on

track, the complexity of the task: think

about the time scale and detail the

process into sub-destinations by

regularly reviewing. Goals must be

clearly measurable, unambiguous, and

there is a period of time. People judge

goals based on the importance of an

anticipated achievement. Objectives

must be understood to be effective. There

is feedback in order to clarify

expectations, adjust the difficulty of the

target and get recognition. Give people

enough time to fulfill the objectives,

considering the complexity of the task.

The objectives of professional education

programs that have been made by each

institution having the same basis or

reference and are of a national nature.

2. Input Aspects

Sub-focus 2. Planning learning systems

for professional Nurse education

programs at Stikes Kota Pekanbaru.

Strategic planning is the blue print of an

organization that is used to build future

success. An inclusive process and

considering current and future trends and

innovations to organize activities that are

needed sustainably, expanding or

developing to remain competitive in the

health care industry (Rousell L., Thomas

PL & Harris JL, 2016) . This statement is

in line with the opinion (Rowland and

Rawland, 2002) that planning begins

with the philosophy of nursing. They

make this planning phase as a stage:

determine goals, collect data, develop

action plans, develop actions, and

evaluate. The input aspect discusses the

planning of the Nurse professional

education program learning system. The

results of the evaluation on the input

aspect are that all institutions have

guidebooks that become references in the

implementation of professional

education programs. The input aspect

also discusses the availability of

resources to support the implementation

of the Nurse professional education

program. The resources needed start

from human resources who will act as a

preseptor, both academic preceptors and

clinical preceptors. The recruitment of

professional program lecturers has

fulfilled the qualifications set in

accordance with the Minister of Research

and Technology regulations No. 44 of

2015, namely having a minimum

education in a nursing master with a

minimum of two years work experience.

The recruitment of clinical preseptors has

qualifications based on PP no.19 of 2005

31


concerning national education standards,

namely having an equivalent level of

education or above from students and

having become clinical advisers for at

least 2 years.

In addition to the receptors, students also

have qualifications in the recruitment

process. The main requirements of

students in the professional program are

to have passed the nursing degree

program as set out in the 2015 KKNI. All

institutions involved have a line and

functional organizational structure. Line

and functional organizational structures

have vertical and horizontal relationships

that must complement each other to

create good coordination within an

organization (Swansburg dan

Swansburg, 2015).

The draft budget for the Nurse

professional education program has been

tailored to the needs of each semester.

According to Government Regulation

No. 19 year 2005 related to financing

standards, in article 62 there are three

types of costs, namely investment costs,

operating costs and personal costs.

Investment costs include the cost of

providing facilities and infrastructure,

the development of human resources and

permanent working capital. Personal

costs are educational costs that must be

spent by students to be able to follow the

learning process regularly and

continuously. Operating costs consist of

salaries of educators and education

personnel as well as all benefits attached

to salaries and consumable educational

materials or equipment.

Personal costs are the main source of

funding in professional education

programs, where students pay tuition

fees every semester. The budget for

professional education program nurses

refers more to operating costs, namely

budgeting is calculated based on the

needs of activities to be carried out at

each stage of the profession. Details of

the budgeted costs include management

fees, structural fees, functional fees. The

budget for the professional education

program team is a personal and

operational budget. This is in line with

the results of the study (Williams and

Taylor, 2008) stating that financial and

organizational commitment is important

to be implemented in clinical practice for

nurse educators.

The facilities and infrastructure on the

student's practice land are sufficient but

there are still equipment that are lacking

so that for the practice students must

bring themselves or borrow from

campus. Students feel uncomfortable

because there is no special room for

discussion rooms and lockers to store

32


their belongings. The results of Manar

Nabolsi's study, Arwa Zumot, Lina

Wardam, FaAthieh Abu-Moghli (2012)

recommend that it is a challenge for

nursing / preseptor educators to support a

conducive learning environment,

improve the quality of student practice

experience, and narrow the gap between

theory and practice.

Preparation of practical activities is

carried out before practicing students,

including by collaborating with

institutions on clinical practice

institutions. The four institutions stated

that before students carry out

professional practice each institution

cooperates with a practical land in the

form of a Memorandum of

Understanding (MoU). In his opinion

(Munir Fuady, 2018) the MoU is a form

of cooperative bond made by both parties

(institutions and practice landowNurse)

formally in the form of legal documents

that explain the agreement between the

two parties who agree with each other

which then binds them in a cooperation

agreement. The aim of the MoU was as a

big picture of the agreement, a

memorandum of understanding was

made and signed by institutional

executive officials where the content was

more general. While the contents of a

more detailed agreement will be made

and negotiated by staff who master

technical matters. The MoU has juridical

benefits and economic benefits. The

support of institutions / institutions in the

implementation of professional

profession education practices, the four

institutions received support from

foundations and clinical practice

institutions by giving opportunities to

students from all four institutions to be

able to practice. This is in line with the

results of the study of Pour Dehkordi and

Shohani (2016) which states that to

improve the quality of nursing practice,

collaboration between educational

institutions and clinical practice

institutions is needed.

3. Process Aspects (Process)

Sub-focus 3. Implementation of Nurse

professional education learning

program at Pekanbaru STIKes.

The curriculum applied is in accordance

with the AIPNI curriculum guidelines.

The curriculum is a set of plans and

arrangements regarding the content, as

well as study materials and lessons as

well as ways of delivery and assessment

that are used as guidelines for the

implementation of teaching and learning

activities. The Nurse professional

education curriculum used is the

Indonesian National Qualifications

standard (KKNI) according to the

33


national standards of higher education.

This is in line with the results of research

conducted by Hall and Guidry (2013)

stating that the Nurse education

curriculum includes the development of

expertise related to the understanding of

the culture and transcultural practices

adopted by the community.

Related to professional student practice

learning activities, the four institutions

carry out learning activities in

accordance with the Nurse professional

curriculum program curriculum guide.

This is in line with the results of the study

(Humphreys, Gidmans and Andrews,

2000) stating the contribution of clinical

practice institutions used including nurse

educators in providing clinical

experience, practical methods of learning

on the ground also have an impact on

students. Research (Salminen, et al,

2009) suggests for the future of nursing

education to be based on nursing facts,

teaching and must improve research on

nursing education.

According to (Swihart, 2007) Nurse

profession practice activities, which are

guided by a preseptor. Receptors are

experienced and competent staff nurses

who receive formal training to function

at this capacity and who act as role

models and resources for new nursing

staff personnel. According to (Adgey,

2018) Preceptorship is a period to

support new nurses who are qualified to

make the transition from students to

develop their next practice. The

preceptorship program is usually 4-6

months. Preceptors are qualified and

experienced nurses whose role is to

support new nurses. Preparation of

clinical and academic preceptors is

carried out jointly with the clinical

practice institutions. The appointment of

Academic preceptors is determined by

the institution while the clinical

preceptor is determined by the leader of

the clinical practice institutions. The

qualification of an academic preceptor is

to have a Masters degree in nursing, a

minimum of two years experience and a

certificate of preceptorship, while a

clinical preseptor is a staff of nurses with

a minimum education with a minimum of

two years experience and a certificate of

preceptorship. Based on the statement of

the profession coordinator from the four

institutions, it was found that the

appointment of preseptors on the practice

land was still not in accordance with the

qualifications of the preseptor

determined.

Guidance activities could evaluate the

implementation of the teaching and

learning process of professional students

on clinical practice institutions. Results

34


of the study (Sari, et al, 2016)

recommending the preseptor model in

clinical learning can improve student

competency achievement. In line with

the results of the study (Jokelainen, et al,

2011) states that using the mentor

method helps students have a better

learning experience and the learning

provided can be done systematically.

Research (Jamshidi, L., 2012) states that

clinical learning must focus primarily on

knowledge skills and attitudes.

Research (Scronce, 2013) on the clinical

conferences in nursing education states

that preceptors must support and

encourage a positive environment that is

conducive to fostering trust, honesty,

openness, sharing and discussion.

Clinical conferences make students feel

comfortable sharing and expressing their

opinions without feeling afraid of being

tried by a preceptor or without fearing

what students say will affect their value.

(Billing and Halstead, 2012) state that the

best thing is the planned clinical success

of the conference. Preceptors must have

ideas or topics that might be discussed,

also flexible enough to allow students to

convey important issues that they

encounter or that make them worry.

Obstacles were found during the

guidance process, for example some of

the clinical preceptors did not conduct

pre and post conferences when students

came to practice. Some academic

preceptors did not come to guide students

on clinical practice institutions. Most

clinic preceptors cannot guide students

because of their busy life as head of ward

and team leader. The researchers'

conclusions are that there needs to be a

change in the process of student scales on

practical land and appoint clinical

preceptors from care staff who can be

used as role models at the time students

practice clinics.

Monitoring and evaluation is carried out

by academic preceptors and clinical

preceptors together by following the

practice guidelines as a reference for

assessment. This was conveyed by all

four institutions. The purpose of

monitoring is to find out whether the

ongoing activities are in accordance with

agreed plans and procedures. Monitoring

is carried out when activities are in

progress to ensure the suitability of the

process and achievements in accordance

with the plan or not. (RI Ministry of

Health, 2017) Evaluation is a series of

activities designed to measure the

effectiveness of the teaching / learning

system as a whole, while learning

evaluation is the process of determining

the acquisition of learning outcomes

based on certain criteria. Evaluation is

35


carried out to find out the final results or

achievements of the activities or

programs carried out at the end of the

activity. The results of the conclusions

obtained, monitoring and evaluation

activities have been carried out by the

four institutions. Competency tests are

conducted to evaluate the achievement of

student competencies after practicing on

a particular stage. The evaluation

includes cognitive, psychomotor and

affective aspects. Evaluation methods

carried out include the Direct

Observational Procedural Skill Test

(DOPS), Student Oral Case Analysis

(SOCA), managed case reports, mini

seminars and counseling presentations.

Clinical learning have to focused on the

knowledge, skill and attitude (Jamshidi,

2012). It can be concluded that the

competency test activities carried out by

the four institutions have fulfilled the

realm of achieving educational goals,

especially professional Nurse education.

Each preceptors makes a final report on

each stase and submits reports on the

results of student activities to the

profession coordinator. According to

experts (about knowledge, 2019) Reports

are a form of presentation of a fact about

a situation or an activity, and basically a

fact that is presented is the responsibility

assigned to the reporter. The matter

presented is in the form of material or

information based on the objective

situation experienced by the reporter

himself or seen, heard and felt by

himself. Reports are made when the

reporter has carried out an activity or an

activity.

4. Product Aspects

Evaluation of product aspects aims to

determine the achievement of the results

of professional Nurse education

programs in Pekanbaru. The aspects

evaluated include the achievement of

curriculum objectives, achievement of

competencies, results of competency

tests and graduation certification.

Evaluations are carried out at various

sources, both from the related data and

also evaluating the parties concerned.

Evaluation results are related to

achieving curriculum objectives based

on the results of national competency

tests, that curriculum objectives have not

been fully achieved. This is concluded

from the passing of the competency test

which is still low and has not reached the

graduation target, which is 100%. This

can occur based on the results of the

analysis of the guidance process during

student practice, namely there are still

limited academic preseptors and clinical

preseptors in guiding students during

36


practice. The clinic preseptor which is

the majority of the head of the room and

the team leader has its own busy life as a

room manager so it is not focused on

guiding students during practice. At the

time of the examination the student still

has limitations in carrying out the exam

using a computer system, students are

still confused with the CBT examination

system, need careful preparation to take

the exam.

Competency testing is carried out with

the aim of obtaining a competency

certificate which will be a requirement in

managing STR. So that students cannot

continue the process of making STR,

where STR is a requirement that must be

met if you want to work professionally.

This has been regulated in the Minister of

Health Regulation Number 1796 of 2011

concerning Registration of Health

Workers.

5. Outcome aspects

Sub-focus 5. Impact of Nurse

professional education graduates.

Placement of graduate graduates who

work from the results of questionnaires

filled in by HR and Nursing managers in

several hospitals in Pekanbaru states that

the placement of graduates is in

accordance with the scientific field with

good work performance, and possessed

competencies according to the expected

criteria. The input from the hospital

where the graduates work is the need for

additional soft skills and local material.

Awal Bros Hospital suggested that Nurse

educational institutions improve their

students' skills, insights and critical

thinking. For graduates who excel in

hospitals promote them as head of the

room and team manager, and send some

of them to attend further education about

special skills in accordance with hospital

needs, such as ICU training,

Hemodialysis and emergencies. In line

with (Swansburg and Swansburg, 2015)

state that training and education

development are needs to produce the

competency which needs in job

appraisal. With professional work

graduates can have an impact on good

cooperation, which is and established

with partNurse in the hospital so that

good teamwork can be formed that can

provide job satisfaction for internal

customers and external customers in this

case patients, families and institutions.

This has an impact on improving the

image of the hospital where they work.

CONCLUSION

Based on the results of the discussion

it can be concluded that in the aspect of sub

37


focus context 1: The objectives of the Nurse

professional education program from the

four institutions have been made in

accordance with the needs of nursing

services by describing them according to the

Tri Dharma of Higher Education which is

made as a guide in the preparation of Nurse

professional education curriculum. In the

aspect of sub focus input 2: The Nurse

professional education program learning

system has been implemented in accordance

with the curriculum guidelines of each

institution. The guide includes a description

of the practice schedule of students, practice

sites, group division, standard assessment

and final evaluation of each stase

undertaken, by considering lecturer

resources with Masters Nursing

requirements, with a minimum of 2 years

work experience. In the aspect of the sub

focus process 3: The implementation of the

Nurse professional education program at the

Pekanbaru STIKes is in accordance with the

practice guidelines that have been made by

each institution. In the process of learning on

clinical practice institutions using the

preseptor method. On the basis of sub-focus

products 4: Achievement of the results of the

Nurse professional education program at

Stikes Pekanbaru is not yet in line with the

achievement targets as evidenced by the

passing of the national student competency

test is still low. In the sub-focus aspects of

outcome 5: The results of Nurse professional

education graduates indicate that graduates

who have worked in both private and public

service facilities are considered good, work

in accordance with their fields and can

contribute in providing nursing services

professionally.

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Adgey, P. (2018). What is Preceptorship and

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menghadapi uji kompetensi Ners

Indonesia. The Indonesian Journal

of Health Science, 7(1), 40-47.

Nabolsi, M., Zumot, A., Wardam, L., &

Abu-Moghli, F. (2012). The

Experience of Jordanian Nursing

Students in their Clinical Practice.

Procedia - Social and Behavioral

Sciences, 46, 5849-5857.

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2012.06.527

Pawar, Y. (2017). Understanding Locke and

Latham’s 5 principles of goal-

setting. Retrieved from

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lathams-principles-goal-setting/

Rousell, P. L. Thomas, & J. L. Harris.

(2016). Strategic Planning and

Change Leadership: Foundations for

Organizational Effectiveness In L.

(Eds.),Management and Leadership

for Nurse Administrator (7th ed., pp.

149). Sudbury, Massachusettes:

Jones and Bartlett Learning.

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Anggreny, Y. (2016). The

Implementation Of Preceptorship

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Achievement Of Nursing Clinical

Students (Implementasi Model

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Pencapaian Kompetensi Mahasiswa

Profesi Ners). Jurnal INJEC, 2(1),

118–125.

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in Nursing Education.

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Yasmin Asih. Editor Monica Ester.

Jakarta: Buku Kedokteran EGC.

Swihart, D. (2007). Nurse Perceptor

Program Builder: HCPro Inc.

Williams, A., & Taylor, C. (2008). An

investigation of nurse educator’s

perceptions and experiences of

undertaking clinical practice. Nurse

Education Today, 28(8), 899-908.

doi:https://doi.org/10.1016/j.nedt.20

08.05.012

Zapko, K. A., Ferranto, M. L. G., Blasiman,

R., & Shelestak, D. (2018).

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https://upraise.io/blog/locke-lathams-principles-goal-setting/

https://upraise.io/blog/locke-lathams-principles-goal-setting/

https://doi.org/10.1016/j.nedt.2008.05.012

https://doi.org/10.1016/j.nedt.2008.05.012

39


ANALYSIS OF THE ROLE OF PERITONEUM CHARACTERISTICS

AND GLUCOSE CONCENTRATION IN DRAIN VOLUME IN CAPD

PATIENTS IN CCI CIKINI HOSPITAL, JAKARTA

Yenny*, Krisna Yetti**,Yusron Nasution***

ABSTRACT

Fluid output in patients undergoing CAPD is influenced by glucose inCAPD fluid which acts as an osmotic agent.

On the other hand the characteristics of the peritoneum indirectly affect ultrafiltration through the rapid or slow

diffusion of glucose from the dialysate into the plasma, thus affecting the difference in osmotic pressure. This study

aims to analyze the role of glucose concentration and peritoneal characteristics of fluid output in patients

undergoing CAPD. The study used Retrospective cross-sectional approach with consecutive data collection methods

sampling . All data are sourced from medical records and patient CAPD diaries from 2005 to 2010. Peritoneal

characteristics are determined based on PET examinations conducted at PGI Cikini Hospital. Measurement of fluid

output was carried out for 7 days based on the patient's CAPD diary, for a period of 1 day to 6 months after PET

examination. The results of the study show different mean output of fluid in the dialysate with different glucose

concentrations and different peritoneal characteristics. T test results showed differences between the average output

of dialysate with a glucose concentration of 1.5% and 2.5% on the day and night (p <0.05) ANOVA test results

showed differences between the mean output between the high transporter with high average transporter and low

average transporter, high average transporters with high transporters , low average transporters with high

transporters ( p <0.05) It can be concluded that glucose concentrations and peritoneal characteristics are equally

responsible for fluid output in patients undergoing CAPD , but the dominant role cannot be concluded.

Keywords: peritoneal characteristics, glucose concentration, output, CAPD

INTRODUCTION

Continuous Ambulatory Peritoneal Dialysis

(CAPD ) is a modality of Peritoneal Dialysis

(PD),which is one of the replacement

therapies for End Stage Renal Disease

(ESRD).12 CAPD is a dialysis technique

using the peritoneal membrane as a dialysis

membrane. Peritoneum classified based on

the Peritoneal Equilibration Test (PET)

examination. PET categorizes peritoneum

into four classifications, namely; high

transporter, high average transporter, low

average transporter and low transporter13, 14.

Glucose in CAPD fluid acts as an osmotic

agent, which results in a difference in

osmotic pressure which affects ultrafiltration

or fluid transfer during CAPD

The difference in osmotic pressure caused

by glucose concentration is one of the

determining factors for fluid transfer across

the peritoneal membrane during CAPD. The

higher the glucose concentration the greater

the ultrafiltration caused.Meanwhile the use

of glucose as an osmotic agent has

advantages and also limitations, because

glucose is not a perfect osmotic agent,

especially for long-term use.On the other

hand the characteristics of the peritoneum

indirectly affect ultrafiltration through the

40


rapid or slow diffusion of glucose from the

dialysate into the plasma, thereby

influencing the difference in osmotic

pressure.

Therefore to achieve a stable fluid balance,

the CAPD fluid glucose concentration and

characteristics peritoneum should be equally

considered. It's just that in Indonesia not all

patients undergoing CAPD have known

peritoneal characteristics.This is because

there are still very few hospitals that conduct

PET examinations.Besides that CAPD

patients are less likely to meet health

professionals than they are with

hemodialysis (HD) patients, so as to obtain

adequate fluid output,generally patients

modify the use of CAPD fluids which is

more hypertonic.The research question

posed in this study is there a more dominant

role between characteristics peritoneum and

glucose concentration to expenditure?

Research methods

This research was conducted in the Renal

unit of PGI Cikini Hospital Jakarta, from

May 10 to June 11, 2010. The design in this

study was crosssectional, with a

retrospective approach.Data were obtained

from medical records and CAPD diaries,

which originated from 2005 to May. 2010,

with a sample of 53 people.The sample in

this study was taken by consecutive method

sampling with inclusion criteria; CAPD

patients that has been tested for PET,uses

CAPD fluid with a glucose concentration of

1.5% and / or 2.5% with a volume of 2 liters

and fluids changes 4 times /day, and having

a CAPD book up to 1 year after the PET

examination date.

Before the requesting approval for the

patient involved in the study, the researcher

provided information related to the

research. Agreement signed patients was

characterized by a consent form and willing

to lend a logbook CAPD for materials

research.After that, it is continued by

recording data from the respondent's CAPD

diary on the recording sheet.The

documented data are: name, date, CAPD

fluid glucose concentration, time of

completion of the CAPD fluid entry, time to

start dialysate,output and fluid balance every

turn.

Record of fluid output is done for one week,

starting (first day) one day after PET

inspection, or the closest date after PET

inspection within one year.Next is recording

the data from the medical record which

includes PET examination results, PET

examination dates, blood sugar levels and

serum albumin.Blood sugar levels used are

the results of laboratory tests, in the same

week,Whereas the results of laboratory tests

41


of serum albumin in the same month output

data from the CAPD diary to be used.

Research result

Table 1. Characteristics of Respondents

Gender (%)

Male 56,6 (30)

Women 43.4 (23)

Age 56.02 ± 12.57

(Mean ± SD) 52,56 - 59,48

95% CI 25 - 78

Min - Max

Blood Sugar

(Mean = SD)

149.17 =

67.09

CI95% 130,68-167,66

Min-Max 72-327

Albumin

(Mean ± SD) 3.31 ± 0.62

95% CI 3.05 - 3.57

Min - Max 2.0 - 4,50

Time after PET

(Mean ± SD) 10.74 ± 31.11

95% CI 2.16 - 19.31

Min - Max 1 - 178

Liquid Expenditures

Morning

(Mean ± SD)

236.75 ±

125.91

95% CI 202.04 -

271.45

Min - Max 14.29 - 721.43

Afternoon

(Mean ± SD)

302.47 ±

757.14

95% CI 260,51 -

344,42

Min - Max 70.00 - 757.14

Afternoon

(Mean ± SD)

233.73 ±

124.07

95% CI 124.07

Min - Max 0 - 707,14

Night

(Mean ± SD)

306.16 ±

167.05

95% CI 260,12 -

352,21

Min - Max 16,67 - 678,57

Cumulative

(Mean ± SD)

1079.10 ±

441.07

95% CI 957,53–

1200,68

Min - Max 16,67 - 678,57

Characteristics of respondents in this study

can be seen in table 1.

Distribution of respondents by sex shows

that most of the respondents are male, that is

equal to 56.6%, with an average age is 56.02

years.The youngest is 25 years old and the

oldest is 78 years old.Blood sugar levels are

above normal value,with the average of

149.17 mg%, where as the mean serum

albumin of 3.31 g / dl CAPD respondents

involved in this study were within a period

of 10.74 days after PET examination(table

1).

42


Distribution of respondents based on

Peritoneum characteristics indicate that the

peritoneum characteristics of respondents

are generally average namely the low

average and high average.(Graph 1)

Most of the respondents used CAPD fluids

with a glucose concentration of 1.5%,

especially in the morning and evening.

During the day the distribution of the use of

glucose concentrations of 1.5% and 2.5%

was quite even, while at night the

respondents used more fluids. CAPD with a

glucose concentration of 2.5% (Graph 2)

Most respondents regulates the use of

glucose concentration based on patterns A

and B. The results of the data analysis also

shows a small portion of respondents did

change the pattern, which means replacing

the CAPD fluid glucose concentration of

1.5% to 2.5% or vice versa between 4 times

exchange(table 2).

6%

38%47%

9%

Graph 1

Distribution of Respondents

Based on the Characteristics

of Peritoneum

High High average

Low average Low

0

10

20

30

40

50

60

1.5

0%

2.5

0%

1.5

0%

2.5

0%

1.5

0%

2.5

0%

1.5

0%

2.5

0%

Morning Noon Afternoon Night

Graph 2Distribution of Respondents

Based on the dialysate glucose concentration

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

43


Output fluids at each change occur most at

night, minimal in the afternoon. In the

afternoon, the lowest output of liquid is 0 ml,

which means that ultrafiltration and

absorption during dwell time occur as large,

so that the balance of fluid is 0 ml. While the

highest average expenditure in the afternoon

amounted to 707.14 ml, which means that

during the dwell time 707.14 ml of liquid

from the net ultrafiltration was released as a

drain volume, also called the negative

balance (tabel 1).

The results of the analysis show that there

are differences in mean fluid output between

the four characteristics of peritoneum. The

average fluid expenditure is mostly in the

high transporter, which occurs every

exchanges except during the daytime, while

the average fluid expenditure varies at least

between the high average transporter and the

low transporter. Further analysis showed a

significant difference in mean fluid output

between the four peritoneal characteristics in

the morning and afternoon (p value

<0.05)Significantly different groups are

high transporters with high average

transporters and low average transporters,

high average transporters with high

transporters, low average transporters with

high transporters. The mean fluid output

during the day and night did not show a

significant difference between the four

characteristics of peritoneum(graph 3).

0 200 400 600

High

High average

Low average

Low

High

High average

Low average

Low

High

High average

Low average

Low

High

High average

Low average

Low

Mo

rnin

g *

No

on

Aft

ern

oo

n *

Nig

ht

Graph 3Average Respondent Fluid

Expenditures Based on Peritoneum Characteristics

* p <0,05

Tabel 2 Distribution of Respondents

Based on The Pattern of Glucose Use

Patte

rn

Morni

ng

No

on

Aftern

oon

Nig

ht

Fre

q.

A 1.5 1.5 1.5 1.5 17

B 1.5 2.5 1.5 2.5 14

C 1.5 1.5 1.5 2.5 11

D 2.5 2.5 2.5 2.5 3

E 2.5 1.5 2.5 1.5 1

F 1.5 2.5 2.5 2.5 1

G 2.5 2.5 1.5 2.5 1

Change

pattern 5

Total 53

44


The highest number of respondents'

cumulative liquid expenditure is also seen in

the high transporter(graph 4). .

The results of data analysis on the role of

CAPD fluid glucose concentration variables

with fluid output showed that the mean fluid

output in respondents using CAPD fluid

with 2.5% glucose concentration was greater

than those using 1.5% glucose

concentration. This difference can be seen

every time you change fluids, namely in the

morning, afternoon, evening and night.

Further analysis appears there was a

significant difference between the mean

output of respondents who use CAPD fluid

with a concentration of 1.5% and 2.5% on

the day and night ( p <0.05). The mean

output of fluids in the morning and evening

did not show a significant difference

between respondents with the use of

different glucose concentrations. (tabel 3)

Tabel 3

The results of the correlation analysis of

fluid and blood sugar expenditure showed a

weak relationship in the morning, but in the

afternoon, day and night did not show

closeness, but all had a negative pattern .

While the correlation of fluid output with

serum albumin showed a strong relationship

at night and in the morning, also the overall

pattern was negative . While the correlation

analysis shows that there is no closeness

between the output of fluid and the time after

PET examination, but it has a negative

pattern, which means there is a tendency that

the longer the time after PET examination

the less fluid output.

Discussion

Most of the patients who underwent CAPD

involved in this study were 56.24 years old,

with age range between 25 to 78 years old.

These results illustrate that renal

replacement therapy with CAPD modalities

can be used on all ages. Patients with various

0 500 1000 1500 2000

High

High average

Low average

Low

ml

Graph 4Average Cumulative Expenditures

Based on the Characteristics of Peritoneum

1,50% 229,33 130,56 45 19,46 0,28

2,50% 286,12 95,46 7 36,08

1,50% 243,39 129,26 31 23,22 0,000

2,50% 389,8 147,48 21 32,18

1,50% 220,26 126,55 45 18,86 0,16

2,50% 303,14 83,11 5 37,17

1,50% 243,03 174,61 20 39,05 0,03

2,50% 344,39 152,46 33 26,54

Morning

Noon

Afternoon

Night

Average Respondent Fluid Expenditures Based on the

Dialysate Glucose Concentration

glucose

concentrationMean SD n SE

p

value

45


levels of age can learn to do CAPD, as well

as for elderly patients , if they do not

experience dementia or visual impairment.

But this situation is not an absolute

contraindication, if indeed CAPD is needed

it can still be carried out, for that we need

help from family or other people who can

help patients in doing CAPD at home.

The most commonly used CAPD glucose

concentration by respondents was 1.5% in

the morning, afternoon and evening. CAPD

fluid with a glucose concentration of 2.5% is

quite widely used in the afternoon and most

at night. This is parallel with the description

of the pattern of use of liquid CAPD based

on fluid turnover time which describes dwell

time.In theory, the concentration of glucose

that is generally used is 1.5%, especially in

the morning, afternoon and evening, which

is at dwell time of 4-6 hours. While CAPD

fluid with a glucose concentration of 2.5% is

generally given at night, due to a longer

dwell time , which is 8-10 hours. Hypertonic

CAPD fluids are also used to obtain more

expensed expenses. 4,6

Glucose is a well-known, relatively cheap

and safe osmotic agent, 11 is also a source of

calories, however glucose is not a perfect

osmotic agent. Glucose acting as an osmotic

agent can cause hyperglycemia,

dyslipidemia, obesity, and damage to the

peritoneal membrane in the long term, either

directly or through glucose degradation

products (GDPs). 2 The higher the glucose

concentration there will be more GDPs

formed. 2 GDPs are toxic, formed during

heat sterilization and CAPD liquid storage.

The peritoneum that is exposed to this toxin

in the long term, can cause it changes in

peritoneal morphology which is

characterized by loss of mesothelial cells,

interstitial fibrosis, vasculopathy, and

neovascularization . as a result there is an

increase in the transport of solutes with

small molecular weights and glucose, which

in turn causes a progressive decrease in

ultrafiltration . 4,6,11 Therefore it is

necessary to be careful in determining the

glucose concentration to be used.

The amount of disbursement of the

respondent's fluids , at most at night, was

306.16 ml, the afternoon was 302.47 ml ,

although the number of differences was not

too large . The more amount of fluid output

at night and during the day can be explained

by the use and regulation pattern of glucose

concentration . In the evening and afternoon,

the most commonly used CAPD fluid

glucose concentration is 2.5%, so the

average output of fluid is greater than in the

morning and evening.

46


The difference in the expenditure of liquid

which is not too large at night and during the

day, can be due to differences in dwell time

. Dwell time at night ranges from 8-10 hours,

while afternoon4–6 hour. Dwell time affect

net ultrafiltration, Mujais and Vonesh(2002)

showed a decrease in ultra filtration net after

the fourth hour, so that at night with a dwell

time ranging from 8-10 hours, after four

hours ultrafiltration will be reduced but the

liquid absorption continues until the next

CAPD exchanges. This situation can cause

fluid output ( drain volume ) at night to be

not too much.

The study also showed respondents who

used CAPD fluid with a glucose

concentration of 2.5% average expenditure

fluid was greater than glucose concentration

1.5%. This difference is mainly seen during

the day and night. Glucose is an osmotic

agent, causing dialysate fluid to be

hypertonic when compared to blood. This

situation results in differences in the osmotic

pressure between the dialysate in the

peritoneal cavity which is hypertonic and the

blood in the peritoneal capillaries is

relatively hypotonic, thus affecting

ultrafiltration or fluid transfer during CAPD.

5.8

But on the other hand glucose as an osmotic

agent, has a low reflection coefficient value

so that the difference in osmotic pressure

caused by glucose quickly disappears. This

decrease in osmotic pressure occurs because

fast glucose diffuses from the dialysate fluid

into the peritoneal capillary. 2 Therefore the

higher the glucose concentration of CAPD

fluid will be higher and the longer the

difference in osmotic pressure between

dialysate and blood can be maintained, so

that it continues to have an effect on

ultrafiltration. This situation is seen in the

use of CAPD fluid with a 2.5% glucose

concentration that is widely used in the

evening and night , so that the average fluid

expenditure is more.

The results of the data analysis further prove

that glucose concentration plays a role in

fluid output, there is a significant difference

in the mean expenditure of fluid between

dialysates with glucose concentrations of

1.5% and 2.5% at day and night (pvalue

<0.05). But in the morning and evening, the

difference is not too big. This can be caused

by a dwell time more length, which is

influenced by work, social activities or other

activities undertaken in the respondent's

daily life. Although it can be assumed that

dwell time in the morning, afternoon, and

evening ranges from 4 to 6 hours, in this

47


study no deep assessment of the respondent's

dwell time was conducted .

Besides that, when compared with the

results of respondent characteristics based

on glucose concentration, it was seen that in

the morning and evening, the respondents

mostly used CAPD with a glucose

concentration of 1.5%. As previously

explained, ultra filtration net at a 1.5%

glucose concentration will decrease after the

fourth hour . 6.9 The amount of

ultrafiltration net will increase slowly if

there is no reabsorption of the peritoneum,

especially through lymphatic.

Reabsorption of the peritoneum persists and

will reduce intraperitoneal volume

throughout the dwell time . 6 Therefore after

the fourthhour the reabsorption of the liquid

will be greater than the ultrafiltration, thus if

there is an addition of dwell time the end

result is a decrease in the amount of liquid

coming out. The difference in osmotic

concentration caused by glucose is generally

maximal at the onset of PD and decreases

over time, because of the dilution of glucose

by the output and also diffusion from

glucose dialysate into the blood. 2 This

situation is certainly inseparable from the

role of the characteristic peritoneum in

influencing glucose diffusion.

Most of the peritoneum characteristics

involved in this study are average, namely

low average and high average . While the

high and low transporters are far fewer in

number, the results of other studies also

show the same thing even in different

percentages. 8 Based on the characteristics

of the peritoneum, it can be stated, in

general, respondents involved in this study

are ideal for substitution therapy with

CAPD, because high average transporters

and low average transporters provide good

dialysis and ultrafiltration. 4

The mean cumulative fluid expenditure

based on peritoneal characteristics also

shows differences. If it is sorted according to

the most fluid output from is as follows; high

transporter, low transporter, low average and

high average. In general, the highest

expenditure of liquid based on peritoneum

characteristics is low transporter, low

average, high average , and high transporter

. 8 In theory, ultrafiltration on high

transporter is not adequate. 4

High transporters have a large effective

peritoneal surface area or high membrane

permeability, so that the osmotic pressure

difference rapidly reduced due to rapid

glucose diffuses into the plasma. This

48


situation will cause low ultrafiltration. But in

this study, the expenditure of high

transporter fluids is relatively more than the

other types of transporters , either in the

cumulative amount or at each fluid change,

except during the day. This relatively more

expenditure of fluids, according to the

researchers can be caused by several factors

including the role of residual kidney fuction

(RKF).

The research conducted by Konings, et al

(2003) show the volume of ultrafiltration of

the peritoneum is inversely proportional to

RKF, the smaller the RKF the greater the

volume of peritoneal ultrafiltration, which

means the output of fluid was also greater.

When referring to the study , a larger output

of the high transporter can be caused because

it decreases or there is no more RKF left.

This study also shows the estimation of the

fluid output intervals in the range of negative

balance and a positive balance. If this

estimate is compared with theory and

previous research, it may be possible for the

population to find a balance of fluids that

differ significantly in individuals different

from the peritoneal membrane - both high

transporters .

Besides that hypoalbuminemia can also be

the cause of the large amount of fluid

secretion in patients undergoing CAPD .

Based on the results of observations of

researchers on respondents with this type of

high transporter obtained 2 of 3 respondents

experiencing hypoalbuminemia while others

do not know the value of serum albumin. In

high transporters, the protein in the dialysate

is high so that serum albumin levels are low.

Furthermore, patients with

hypoalbuminemia have low oncotic pressure

and ultrafiltration tends to be higher. 2

The average cumulative fluid expenditure in

respondents with the average transporter

peritoneum is the lowest when compared to

other peritoneal transporters, but still in

accordance with the estimated reference of

fluid output.Twardowski ( 1989 ) states that

high average and low average peritoneum

provides good ultrafiltration . 4 This

situation is also seen in this study where the

standard dosage of CAPD expenditure of

fluid in the low average and high average is

not too much different.

Output inthe low transporter is second only

to high transporter. Peritoneum The low

transporter peritoneum has a low

permeability membrane or small effective

peritoneal surface area, so that the osmotic

pressure difference doesnot rapidly reduced

because glucose doesnot quickly diffuses

into the plasma. This situation causes

49


excellent ultrafiltration, but dialysis is poor,

so high-dose CAPD is needed . 4

If again referring to different sources can be

seen in the low transporter, to get the

maximum ultrafiltration it takes a longer

dwell time.6,8This is the reason for this

study that the average fluid expenditure in

the low transporter is relatively almost the

same at the turn of the liquid morning,

afternoon and evening. Whereas at night

more fluid is released because of the longer

dwell time , which is 8-10 hours.

A further analysis of fluid secretion based

on peritoneal characteristics showed a

significant difference in mean fluid output in

the morning and evening (pvalue <0.05). But

during the day and night there is no

difference in fluid expenditure which is

significant between the characteristic types

of peritoneum, as well as the release of

cumulative fluid. The results of this data

analysis when compared with the

characteristics of respondents based on

glucose concentration, it is seen that the use

of glucosa 2.5% is more used in the day and

night. According to researchers the

hypertonic CAPD fluid may play a more

dominant role in fluid output than peritoneal

characteristics. Therefore, further research is

needed to answer this assumption.

The mean blood sugar level in this study was

149.17 mg%. In theory, glucose absorption

that occurs in patients undergoing CAPD

can cause hyperglycemia in patients who

suffer from diabetes or who experience

impaired glucose in tolerance. 13Statistical

analysis shows that there is a strong

relationship between blood sugar levels and

output in the morning, and the overall

pattern is negative. These results indicate

that there is a tendency for higher blood

sugar levels to be less fluid.

The difference in osmotic pressure between

the dialysate in the peritoneal cavity and the

blood in the peritoneal capillary will be

reduced if there is hyperglycemia. Systemic

hyperglycemia can affect fluid secretion

with reduced osmotic gradient differences. 6

Because ultrafiltration depends on the

difference in glucose between the peritoneal

membrane. But further studies need to be

done to see other possible factors that

influence the closeness of the relationship

between blood sugar levels and output.

The mean albumin serum of respondents in

this study was 3.31 g / dl , with ranges

between 2.00–4.5 g / dl . During the CAPD

process one of the physiological elements

which is also wasted through dialysate is

protein, and 75% of the missing protein is

50


albumin . 10 Albumin is a large molecular

weight protein and utilizes large pores ( large

pores ) to move across the peritoneal

membrane. 8 The average albumin release

through dialysate is 9 g / day,

hypoalbuminemia is generally minimal if

protein intake is adequate . 2

Albumin is the main protein in human

plasma 10 with one of its functions

regulating oncotic pressure in blood vessels.

Oncotic pressure acts to maintain fluid in the

blood so that it is in contrast to ultrafiltration.

Further data analysis in this study showed a

moderate relationship between expenditure

of fluid with serum albumin in the afternoon,

but was very weak in the morning, afternoon

and evening and had a negative pattern . This

means that there is a tendency for lower

albumin levels to be more fluid. As stated,

patients who experience hypoalbuminemia

have low oncotic pressureand ultrafiltration

tends to be higher. 2 But further studies need

to be done to see the possibility of other

factors that influence the closeness of the

relationship.

Most of the CAPD daily records of

respondents involved in this study were

within 1 day up to 170 days after the PET

examination, with an average of 10.74 days.

PET is generally examined after one month

the patient underwent a CAPD catheter

implant, or after the patient's condition is

stable. In this study the time after PET

indirectly gave a long description of the

respondents having undergone CAPD,

where the more days after PET examination

meant the longer the patient had undergone

CAPD. In general, peritoneal transport is

stable over time, but studies in a small group

and in a short follow-up period show that in

some patients there is a change in peritoneal

transport . 3 The results of the data analysis

further show that there is no closeness in the

relationship between expenditure of liquid

and time after PET but has a negative

pattern. This means that there is a tendency

for the longer to undergo CAPD, the less

fluid output. This shows that the tendency to

reduce fluid expenditure over time needs to

be further assessed .

Conclusion

The researcher concluded that the

characteristics of the peritoneum and CAPD

fluid glucose concentration equally affected

fluid secretion in patients undergoing

CAPD. The glucose concentration

commonly used is 1.5% with peritoneal

averagecharacteristics. Expenditure offluid

in the use of CAPD with a glucose

concentration of 2.5% more than 1.5%.

There are differences in mean fluid output

51


between respondents with different

peritoneal characteristics, especially

between high transporters and high average

transporters and low average transporters;

high average transporter with high

transporter; low average transporter with

high transporter.. More extensive research is

needed to assess whether there is a more

dominant role between peritoneal

characteristics and CAPD fluid glucose

concentration.

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2010.http://www.pdinterest.ca/files/

sec4fluidassessment.pdf

Blake, P.G., & Dougirdas, J.T. (2007).

Physiology of peritoneal dialysis.

Dalam J.T. Dougirdas, P.G . Blake &

T.S. Ing (Ed). Handbook of dialysis

(hal 323-338). Philadelphia:

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Heimburger, O., Wang, T., &Lindholm, B.

(1999). Alterations in water and

solute transport with time on

peritoneal dialysis. Perit Dial Int19

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pdiconnect.com/cgi/reprint/19/Suppl_2/S83

Kallenbach, J.Z., Gutch,C.F., Stoner, M.H.,

& Corca, A.L. (2005). Review of:

Hemodialysis for nursing and

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Khana, R., Nolph., K & Oreopoulos, D.G.

(1993), The essential of peritoneal

dialysis. Dordrecht: Kluwer

Acadedemic Publishers.

Khana, R., & Nolph, K. (2009). Principles of

peritoneal dialysis. Februari 7,2010.

http://www.

kidneyatlas.org/book5/adk5-04.pdf.

Konings, C.J.A.M., Kooman, J.P.,

Schonck, M., Struijk, D.G.,

Gladziwa, U., & Steven J., et al.

(2003). Fluid status in CAPD

patients is related to peritoneal

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evidence from a longitudinal study.

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803. Mart 8, 2010.

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Misra, M., & Khanna, R. (2008).

Mechanism of solute clearens and

ultrafiltrasion in peritoneal dialysis.

Juli 15, 2009. www.uptodate.com.

Mujais, S., Nolph, K., &Vonesh, E.

(2002). Profiling of ultrafiltration.

Kidney International, 62, ( 81), S17–

S22, Juni 17, 2010.

http://www.nature.com/ki/

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Parsudi, I., Siregar, P., & Roesli, M.A.

(2006). Dialisis peritoneal. Dalam

A.W. Sudoyo, B. Setiyohadi, I. Alwi,

M. Simadibrata, & S. Setiati (Ed.).

Buku Ajar Penyakit Dalam (hal.592-

595). Jakarta: Pusat Penerbitan

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Fakultas Kedokteran Universitas

Indonesia.

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plasma, imunoglobulin dan

pembekuan darah. Dalam R.K.

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(Andry Hartono, Penerjemah) EGC.

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Saxena, R., &West, C. (2006, July–August).

Peritoneal dialysis: a primary care

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Sharma, A., & Blake, P.G. (2008).

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Brenner (Ed.). Brenner & Rector’s:

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207-261). St Louis Missouri:

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http://www.jabfm.org/

53


RELATIONSHIP OF THE MOTHER EDUCATION LEVEL WITH THE

GROWTH OF TODDLERS IN POSYANDU RW 12 PUSKESMAS

KELURAHAN GEDONG JAKARTA TIMUR

IGA Dewi Purnamawati

Nursing Academi Pasar Rebo Jakarta


ABSTRACT

Toddler is a golden period , a window of opportunity and a critical period for the continuity of the child's growth and

development.. The mother is the closest person to the toddler, the person who is cared for toddlers and who played a

role in making decisions about the child's health condition. The research aims to find the relationship between mother's

education level and the growth of children . The study used an analytic survey with cross sectional approach on 88

respondents obtained by the method of consecutive sampling. The results of chi square analysis with p value> 0.05

showed that there was no relationship between mot her's education level and weight end height growth with a value of

Pvalue = 0.48 and growth of toddler's upper arm ci rcumference with Pvalue = 0.68. This study recommends research

on the analysis of factors that affect toddler growth and development.

Keywords: Growth , Mother’s education, and toddlers

INTRODUCTION

The growth of children under five is an

important thing that must be considered by

parents, society and even by the state. Every

child will go through a growth process

according to their age. Growth monitoring

can be done by parents, health workers,

educators, cadres and other workers who are

interested in child development. Child

growth and development are basically the

same for every child, so knowing the

characteristics and principles of growth and

development will make it easier for parents

to provide growth and stimulation as needed

(Ministry of Health, Republic of Indonesia,

2014). Growth is an increase in physical size

while development is a process where the

child experiences an increase in a variety of

skills and functions. Assessment of a child's

physical growth such as weight and height on

an ongoing basis is very important so that

growth that is too fast or inadequate can be

identified early (Kyle & Carman, 2014).

Growth b Alita requires stimulation,

stimulation is needed to stimulate the basic

abilities of children so that children grow

optimally. Stimulation per grows late should

be done regularly, as early as possible and

continuously by their parents or caregivers of

children (Kemenkes RI, 2014).

Based on the results of Riskesdas (2013)

toddlers who experience very thin conditions

54


are still quite high 5.3 percent, 12.1 percent

thin and 11.9 percent fat, according to WHO

(2010) health problems have been said to be

serious if the prevalence of thinness between

10.0- 14.0 percent and is considered critical

if ≥ 15.0 percent. In 2013 the prevalence of

under - fives was still 12.1 percent, which

means that underweight problems in

Indonesia were still a serious health problem.

In 2013 there were 19.6% undernourished

children consisting of 5.7% undernourished

children and 13.9% undernourished states,

the data stated that the number of

malnourished children under five rose every

year (Hardianti; Dieny & Wijayanti, 2013).

There is still a high nutritional problem for

children under five in Indonesia, so it

requires hard work to reduce health problems

in the community. Damanik; Ekayanti; &

Hariyadi ( 2010 ) in ( Todaro & Smith, 2009)

suggested that WHO has found five

conditions that cause 70% of under-five

deaths including acute respiratory infections,

diarrhea, chickenpox, malaria and

malnutrition, it is estimated that if this trend

continues , then in 2020 this condition will

cause 30% of child deaths worldwide.

Adequate or deviant child growth can be

monitored through measurements of body

weight (height) , height (TB) and upper arm

circumference (LLA) of children. Based on

the Ministry of Health of the Republic of

Indonesia (2014) child growth can be seen

from body weight (body weight) and height

(TB) using the BB / TB table (Directorate of

Community Nutrition 2002) the results will

be categorized whether the child has physical

growth. Fat, Normal, Skinny and Very Thin.

Growth and developmental deviations can

include speech disorders, cerebral palsy,

down syndrome, short stature, hyperactivity

and autism disorders . Factors that influence

children's growth are influenced by internal

and external factors. Internal factors include

race, family, age, sex and genetics, while

external factors include the conditions of the

mother during prenatal, intranatal and

postnatal conditions. One of the postnatal

factors such as socioeconomic family. Socio-

economic includes residence, mother's

education level and family wealth index

(Kemenkes RI, 2014; IDHS 2012).

Changes that occur continuously on people's

behavior are caused by increasing levels of

education. Associated with the quality of

human life, there is a tendency that the higher

level of education is possessed, the more

knowledge will become and the result in an

increase in the quality of life especially in the

health sector (Indonesia Health Profile,

2014).

Based on the 2012 IDHS, maternal education

has an inverse relationship with the risk of

55


child mortality. A high level of maternal

education is generally associated with a low

risk of death, this is because education makes

mothers get better information on pregnancy

and child care. The infant mortality rate is

77% lower in women who have some college

education Compared to children Whose

mothers have low education (15 and 66 kema

tian per 1,000 births). Based on the results of

the survey on the level of maternal education

can reduce mortality in children, researchers

assume that the mother's education is closely

connected with the growth and development

of infants, because the mother will get

information about the growth and

development of children is better than

mother experience and upbringing low.

The Concept of Toddler Growth

1. Definition of Growth

Growth is an increase in the size and number

of cells and intracellular tissue or increase in

physical size and body structure in parts or in

whole and can be measured in units of length

and weight (Kemenkes RI, 2014) .

2. Toddler Growth

The most prominent picture in childhood is

physical growth . During development,

various tissues in the body experience

changes in growth, composition and

structure. Height development in children is

almost entirely due to skeletal growth and is

considered a measure of stable general

growth (Wong. 2008). In newborns up to 6

months the growth of body weight increases

from 140 to 200 grams of birth weight to be

doubled at the end of the first 4 to 7 months.

Weight gain in infants aged 6 to 12 months

gained 85 to 140 grams of birthweight three

times at the end of the first year. At the age

of toddler and pre-school weight gain 2 to 3

kilograms each year. In infants aged 0 to 6

months, height increases about 2.5 cm each

month and ages 6 to 12 months increase

around 1.25 cm and 6 to 8 cm in the 2nd and

3rd year. the body of the child is twice the

length of birth and at the age of 5 years the

body height increases from 5 to 7 , 5 cm

(Wong, 2008).

3. Weight Measurement ( BB ) :

a. Using baby scales.

1)Baby scales are used to weigh

children up to 2 years of age or

while the child is still able to lie

down / sit quietly.

2) Place the scale on a flat table and

not easily sway.

3) Look at the position of the needle

or the number must point to the

number 0.

4) Babies should be naked, without

hats, socks, gloves.

56


5) Lay the baby carefully on the

scale.

6) Look at the needle scale until it

stops.

7) Read the number indicated by the

scale needle or the scale number.

8) If the baby continues to move, pay

attention to the movement of the

needle, read the number in the

middle between the movement of

the needle to the right and left.

b. Using the stampede scales.

1) Place the scales on a flat floor so it is not

easy to move.

2) Look at the position of the needle or the

number must point to the number 0.

3) Children should wear thin everyday

clothes, not wear footwear, jackets, hats,

watches, necklaces, and not hold

anything.

4) The child stands on the scale without

holding it.

5) See the needle scale until it stops.

6) Read the number indicated by the scale

needle or the scale number.

7) If the child continues to move, pay

attention to the movement of the needle,

read the number in the middle between the

movement of the needle to the right and

left.

c. Measurement of Body Length (PB) or

Height (TB) and Upper Arm Circumference

(MUAC) :

1) How to measure by lying down.

2) How to measure in a standing

position.

4. Use of Table BB / TB (Directorate of

Community Nutrition 2002 ).

a. Measure the height / length and weigh

the child's weight, according to the

method above.

b. Look at the child's Height / Length

column that matches the measurement

results.

c. Select the Weight column for

male (left) or female (right)

according to the sex of the child,

look for the body weight closest

to the child's weight.

d. From this weight figure, see the

top of the column to find out the

Standard Deviation (SD)

number (BB / TB table in the

appendix)

e. BB / TB Interpretation: Normal:

- 2 SD to 2 SD, Thin: - 2 SD to

- 3 SD, Very thin: - 3 SD and

Fat: 2 SD.

5. MUCH measurement

Lila measurement is an indirect

measurement of muscle mass. The way to

57


do the measurement is by placing the

meter vertically, along the posterior part

of the upper arm to the acromial process

and to the olecranon process half of the

measurement length is the midpoint.

Interpretation of LILA <11 cm in lean

children, .11-14 cm in normal children

and> 14 cm in fat children.

6. Mother's Education

Education in the Big Indonesian

Dictionary (2008) is the process of

changing attitudes and behavior of a

person or group of people in an effort to

mature humans through teaching and

training efforts. According to Arikunto

(2002) the education level category is

divided into two, namely elementary

school to junior high school education

while higher education starts from high

school to university level. Based on the

2012 IDHS, maternal education has an

inverse relationship with the risk of child

mortality. A high level of maternal

education is generally associated with a

low risk of death, this is because

education makes mothers get better

information on pregnancy and child care.

The infant mortality rate is 77% lower in

mothers with tertiary education

compared to children whose mothers

have low education (15 and 66 deaths per

1,000 live births).

RESEARCH METHODS

The design of this research is descriptive

analytic design with cross sectional research

approach . Study cross sectional / cross-

sectional is a type of non-experimental

observational study where Researchers

conducted observations / measurements of

variables at a particular moment. In this

study, researchers wanted to find the

relationship between the independent

variable as a risk factor and the dependent

variable as the effect by taking a momentary

measurement. The independent variable (risk

factor) in this study is the level of mother's

education. The dependent variable in this

study is toddler growth. The reason the

researcher used this design was to identify

the presence or absence of a relationship

between the independent variable (mother's

education level) and the dependent variable

(toddler growth) at the same time as one

measurement using a questionnaire, a scale

and meter.

Population and Sample

Sampling in this study using consecutive

sampling method is to take all the samples

found and meet the specified requirements

until the specified amount is met. The subject

criteria (inclusion criteria) in this study are:

Age of toddlers ie 3-60 months , Mothers

who have toddlers and are willing to be

58


respondents and can communicate well

verbally , while exclusion criteria in this

study are toddlers who come to Posyandu but

age has exceeded 60 months and refused to

be a respondent.

Data analysis

Data analysis in this study is univariate

analysis, the purpose of this analysis is to

describe the characteristics of each studied

variable, which consists of independent

variables covering the level of maternal

education and the dependent variable also

performed univariate analysis which is age,

sex and toddler growth ie BB / TB and LLA

. The second stage is to conduct a bivariate

analysis by looking for the relationship

between the two variables. This analysis was

carried out after univariate analysis and the

characteristics of each variable were known.

The purpose of this analysis is to prove

whether there is a relationship between the

independent variable consisting of the level

of mother's education to the dependent

variable, namely the growth of infants .

RESULTS RESEARCH

The presentation of the results of this study

will be displayed in two stages of

presentation, namely the presentation of the

results of univariate analysis and the results

of bivariate analysis. Univariate analysis

describes a description of the variables

studied including the level of maternal

education, age of children under five, sex of

children under five, BB / TB and LLA.

Table 1. Frequency Distribution of

Mother Education Level for Toddler

Children in Posyandu RW 12, Puskesmas

Kelurahan Gedong, East Jakarta.

No Mother

Education

Level

Frequency Relative

Frequency (%)

1 No school 2 2.27%

2 Elementary

school

11 12.50%

3 Middle

School

24 27.27%

4 High

school

42 47.72%

5 PT 9 10.22%

total 88 100%

From the table above shows the level of

education of mothers of children under five

is the majority graduated from high school,

which is 46.73% of the number of mothers of

children under five 88 who are respondents

in this study. While there are 2.17% of

mothers of children under five who have

never attended formal education. If

categorized as low education level, mothers

of toddlers are around 42.04% mothers of

toddlers with low education and 57.94%

mothers of toddlers with high education. The

low education level here is mothers who

don't go to school, elementary and junior

high school, while mothers with high

59


education levels are mothers who have

graduated from high school /vocational level,

Diploma I, II and III as well as Bachelor.

Table 2. Frequency Distribution of

Mother Educational Levels of Toddler

Children in Posyandu RW 12, Puskesmas

Kelurahan Gedong, East Jakarta.

No Mother

Education

Level

Frequ

ency

Relative

Frequency (%)

1 Low

Education

Level

37 42.04%

2 Higher

Education

Level

51 57.94%

Total 88 100%

The education level of mothers of children

under five in the Gedong region was 57.94%

with high education and low education with

42.04%. Based on the growth and

development factors of a child can be

influenced by external factors, one of which

is the mother factor. The mother factor here

is related to mother's education and mother's

knowledge about caring for her toddler.

Mother's education has an important role in

preventing underweight in toddlers. A

mother can determine how to determine the

parenting style she will choose especially in

choosing food for her nursery ( Damanik;

Ekayanti; & Hariyadi, 2010 ).

Table 3. Distribution of Toddler Sex in

Posyandu RW 012 Puskesmas Kelurahan

Gedong

No Toddler

Sex

Frequency Relative

Frequency

(%)

1 Man 49 55.68%

2 Girl 39 44.31%

total 88 100%

From the table above illustrates the sex of

children under five in RW 012 Kelurahan

Gedong is male as much as 55.4% while the

sex of toddler as many as 44.5%. The sex of

a child's growth also affects the growth of a

child. The growth of girls is faster than boys

of all ages (Wong, 2008).

Table 4. Distribution of Toddler Age

Frequency at Posyandu RW 12,

Puskesmas Kelurahan Gedong, East

Jakarta.

No Toddler

age

Frequency Relative

Frequency

(%)

1 Infants (1

- 12

Months)

24 27.27%

2 Toddler

(13 - 36

Months)

31 35.23%

3 Preschool

(37-60

Months)

33 37.50%

total 88 100%

Based on the frequency table above, it

illustrates that preschool age is prioritized

with 40.21% followed by toddler and infant

age. Infancy is a period of rapid motor,

cognitive and social development with the

baby's mother forming the basis of trust in

60


the world and the basis of interpersonal

relationships in the future. At toddler age is a

time of great physical and personality

development and requires broader social

relationships , and studying the role

standards for that growth of toddler age is

important to always be monitored.

Table 5. Weight / Height Distribution of

Toddler in P osyandu RW 012 Puskesmas

Kelurahan Gedong.

No Toddler

Nutritio

n Status

(BB /

TB)

Freque

ncy

Relative

Frequency

(%)

1 Thin 3 3.41%

2 Normal 84 95.45%

3 Fat 1 1.13%

total 88 100%

Based on the frequency table above the

nutritional status of children under five in

Posyandu RT 012 Puskesmas Gedong

Village a percentage of 3.41% of children

under five have underweight nutritional

status, 95.45% have normal nutritional status

and 1.13% under five have underweight

nutritional status. Weight and height is one

indicator in determining nutritional status,

proportionally normal and healthy toddlers

get older and are followed by weight gain.

Likewise, increasing height increases body

weight and increases the size of a toddler's

upper arm circumference.

Table 6. Distribution of Toddler Upper

Arm Circular Frequency at Posyandu RW

12, Puskesmas Kelurahan Gedong, East

Jakarta.

No Upper

arm

circumfer

ence

Frequen

cy

Relative

Frequency

(%)

1 Thin 1 1.13%

2 Normal 25 28.40%

3 Fat 62 70.45%

total 88 100%

Bivariate analysis is used to analyze the

relationship between the independent

variable and the dependent variable. This

study uses a chi-square test with an alpha

value of 0.05 to find out whether there is a

relationship between maternal education

level and the growth of children under five.

Variables tested by bivariate analysis were:

the level of education of mothers with under-

five growth in the BB / TB and LLA

components.

61


Table 7. Analysis of the relationship between the Mother level of education and BB / TB for

toddlers in Posyandu RW 012 Puskesmas Gedong Kelurahan 2017 (n = 88) NO Mother's

Education

Level

Toddler Growth Total

P.

Value BB / TB

Thin

Normal

Fat

N % N % N % N %

1 Low 1 2.7 35 94.6 1 2.7 37 42.04 .478

2 High 2 3,9 49 96.1 0 0 51 58:00

Total

3 3.4 74 95.5 1 1.1 88 100

Table 8. Analysis of the relationship between the Mother levels of education end toddler

LLA in Posyandu RW 012 in Gedong 2017

NO Education

Level

Toddler Growth Total

P. Value

LLA

Thin

Normal

Fat

N

%

N

%

N

%

N

%

0.682

1 Low 0 0.0 11 29.7 26 70.3 37 100

2 High 1 2.0 14 27.5 36 70.6 51 100

total

1 1.1 25 28.4 62 70.5 88 100

62


DISCUSSION

This research categorizes mother's

education levels into two namely low and

high education levels. The results of this

study indicate the level of education of

mothers

under children under five in the Gedong

village health center as many as 51 mothers

or

58% have toddlers with normal BB / TB

growth of 96.1%, while mothers with low

education levels are 37 people or 42.04%.

Statistical test results show the value of P

Value = 0.428 so it can be concluded that

there is no relationship with the level of

education of mothers with the growth of BB

/TB toddler. Unlike the case with the results

of research Waqidil and Adini (2014) the

results of the study with the title of the

relationship between the level of education

of mothers with the development of toddlers

aged 3-5 years. The study resulted in a

relationship between mother's educational

level with the development of toddler found

p: 0,000 <α: 0.05. Normal growth is not

only influenced by one factor. Factors that

can affect the growth of children under five,

especially body weight and height are

maternal factors including education and

work status of the mother , family income,

nutritional knowledge, sanitation hygiene,

and health services (Arini, 2018). Unlike

the case with the results of research

conducted by Damanik; Ekayanti; &

Hariyadi ( 2010 ) low maternal education

balitannya chance to experience Stunting

1:27 times compared with infants whose

mother's education level is above junior or

setin g kat. Mother's education plays an

important role in determining the level of

nutritional adequacy. The prevalence of

stunted children as an indicator of

undernourished children is lower in mothers

of higher education levels with any income.

The results of this study indicate the level of

education of mothers under five in the

Gedong village health center as many as 51

mothers or 58% have toddlers with normal

LLA growth of 27.5%, and 70.6%

overweight while mothers with low

education levels of 37 people or 42.04%

have toddlers with Normal LLA growth is

29.7% and Fat is 70.3%. Statistical test

results show the value of P Value = 0.682

so it can be concluded there is no

relationship between the mother's education

level and the growth of toddler LLA.

CONCLUSION

1. Obtained a picture of the age of children

under five and sex of children under five

in Gedong Village where the age of

63


toddlers who come to Posyandu

Kelurahan Gedong is 40.01% is

preschool age ie ages 3 to 5 years. As for

the sex of toddlers most are male with a

percentage of 55.40%.

2. Obtaining overview of education mother

toddler in Gedong village where

education level is most highly educated

mothers with a percentage of 57.63%, ie

at least high school and educated

Bachelor maximum.

3. Obtained a picture of growth in body

weight (BB) , height (TB) and Upper

Arm Circumference in toddlers in

Gedong Village where the growth of

toddlers seen from the height of the

highest body weight is at normal or

around 95.45%.

4. Obtain an overview of the relationship

between mother's education level and the

growth of children under five in the

Gedong Village Health Center, East

Jakarta. This study resulted in no

relationship between maternal education

level with the growth of BB / TB under

five and LLA under five with a P value

of 0, 478 for the relationship of maternal

education level with the growth of BB /

TB and the results of P value 0, 682 LLA

of children under five.

Thank You Note

Thank you to Nursing Academy Pasar Rebo

to all those who have contributed a lot in

doing this.

BIBLIOGRAPHY

Ati , CA ; Alfiyanti, D & Solekhan, A.

(2013). The relationship between

nutritional status and the gross

motor development of children

under five in Tugurejo District

Hospital . Semarang.

Darma KK 2011. Nursing Research

Methodology . Trans media info.

Jakarta

D ahlan, MS (2014). Steps for

Making a Medical and Health

Research Proposal . Jakarta:

Sagung Seto

Hastono, S. (2007). Health Data Analysis

Module . Faculty of Public Health,

University of Indonesia

Judkins-cohn, TM, & Kielwasser-withrow,

K. (2014). Ethical Principles of

Informed Consent: Exploring

Nurses' Dual Role of Care

Providers and Researchers, 45 (1).

http://doi.org/10.3928/00220124-

20131223-03

RI Ministry of Health. (2014). Guidelines

for Early Childhood Development

and Detection .

Kasenda, MG; Sarimin, S & Obnibala, F.

(2015). Relationship of nutritional

status with fine motor development

in preschool children in GMIN

Solafide Kindergarten, Uner

Subdistrict, Kawangkoan

Subdistrict, Minahasa Regency.

ejournal nursing volume 3.

64


Resnik, DB (2015). What Is Ethics In

research & Why is it important?

National Institute of

Environmental Health Sciences.

Ministry of Health of the Republic of

Indonesia. Riskesdas Results.

(2013).

www.depkes.go.id/resources/down

load/general/Hasil%20Riskesdas%

202013.pdf.

Sastroasmoro, SC, & Ismael, S. (2011).

Fundamentals of clinical research

methodology , 4th Edition Jakarta:

Sagung Seto.

Ministry of Health of the Republic of

Indonesia. Indonesian

Demographic and Health Survey.

(2012).

www.depkes.go.id/.../profil-

kempuan-indonesia/profil-

kempuan-indonesia-2012.pdf

http://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf



65


THERAPEUTIC PLAY OPTIMALIZATION IN PEDIATRIC POST

OPERATIVE PAIN WITH LEVINE’S CONSERVATION

MODEL APPROACH

Siti Nurhayati

E-mail: [email protected]

ABSTRACT

Surgery still remains in a great number among children each year. Post operative pain is a traumatic

experience that become general problem among children with surgery. Pain treatment, including

farmakologic and nonfarmakologic management is needed. The aim of this study is to provide an overview

of therapeutic play as a nonfarmakologic management of post operative pain with Levine’s Conservation

Model approach. There were five managed cases that discussed in this study, and all of those experiencing

post operative pain problems. The trophicognosis of pain, based on assessment incuding: energy

conservation, structural, personal and social integrity. Children with therapeutic play showed decreased

of pain and adaptation faster. Therapeutic play as theraphy need a good cooperation among health care

provider.

Keywords: therapeutic play, post operative pain, Levine Conservation Model

Preliminary

Children who experience malignancy,

injury, or are born with congenital

abnormalities, and other acute diseases

will experience impaired organ function

and will affect children’s life. In these

conditions surgery is often needed as an

unavoidable option (Bowden &

Greenberg, 2010). The majority of

children experience moderate to severe

post-surgical pain (Baratee, Dabirian,

Yoldashkhan, Zaree, & Rasouli, 2011).

For that we need adequate pain relief,

both pharmacological and

nonpharmacological.

One of non-pharmacological therapy

that can give is playing therapeutic.

Therapeutic games carried out with the

purpose of reducing fear and discomfort

faced by children during the experience

of care, which is usually done by nurses

(Hockenberry & Wilson, 2012). The

study conducted by Athanassiadou,

Tsiantis, Christogiorgos, and Kolaitis

(2009) proved that puppet play in

children aged 4-6 years can reduce

postoperative aggressiveness and

hyperactivity.

Levine's conservation model approach to

pain management in postoperative

children is carried out as an effort to

obtain conservation: energy, structural

integrity, personal integrity, and social

integrity. One of them is conservation

66


through playing therapeutic by storing

energy and reducing unnecessary energy

use such as crying, excessive movement

and changes in vital signs.

APPLICATION OF NURSING

THEORY IN NURSING CARE

Case Overview

Case 1

Y, (1 year 5 months), after the cut stump

operation. Energy conservation: weight

11 kg, height 75 cm , the patient is rather

fussy and a little weak because he is

fasting and no interest to interact.

Conservation of structural integrity:

Consiousness level is composed mentis,

temperature 370C, pulse frequency 105 x

/sec, RR 40 x/sec, moist lip mucosal,

elastic skin turgor, normal bowel sounds,

warm akral, CRT < 2 sec. Conservation

of personal integrity: he is the 1st child,

lives with his parents who always look

after him and the patient is. Conservation

of social integrity: the patient is always

watched by his mother and sometimes

with his father. The family hopes that

An.Y will immediately recover and be

normal like other children.

Trophicognosis is enforced: the risk of

deficit fluid volume, the risk of

nutritional imbalance: lack of body

requirements, pain, and potential

complications of infection.

Interventions that have been carried out

include observing signs of pain scale,

maintaining a comfortable position for

the child, taking care of the perianal with

the mother. Evaluations conducted on

February 22, 2016 were obtained:

deviation of fluid volume did not occur,

nutritional imbalance: less than body

requirements did not occur, pain was

resolved, and infection did not occur

Case 2

RA, children (8 months), with PSARP

surgery on February 23, 2016.

Assessment on February 24, 2016.

Energy conservation: weight 6.8 kg,

height 64 cm, post-surgery children

become fussy and nervous about the pain

scale (FLACC Scale) 4. Eat porridge one

portion, drink gradually. Conservation of

structural integrity: pulse frequency 115

x/sec, RR 36 x/sec, sound of breathing

Ronchi, coughing occasionally.

Conservation of personal integrity The

client lives with his parents, the second

child are twin. Since hospitalized, R

become more fussy, often cry and not

interested to interact with other people.

Conservation of social integrity: the

client is always watched by his mother

67


and sometimes with his father. After the

operation, parents are took turns because

of fussy children. Parents ask for how to

care for it to succeed. Trophicognosis is

found: ineffective airway clearance, risk

of fluid and electrolyte imbalances, pain,

damage to skin integrity, potential

infectious complications, and lack of

knowledge.

Interventions carried out among others

monitor vital signs, observe the scale of

pain, provide distraction techniques,

educate families how to care for children

with post PSARP. Results of the

evaluation on 29 February 2016: the

airway clearance was effective, fluid and

electrolyte imbalances did not occur, the

pain was resolved, damage to the

integrity of the skin had not been

resolved, the infection did not occur, and

lack of knowledge was resolved.

Case 3

AA, (3 years), underwent laparoscopic

herniotomy on March 2, 2016.

Assessment on March 3, 2016 at 09.00;

Energy conservation: weight 12 kg,

height 84 cm , clients appear active and

easy to smile when invited to talk to

anyone. After surgery the child becomes

fussy and agitated on the pain scale

(VAS) 3-4. Postoperative drinking and a

diet free gradually. Conservation of

structural integrity: level of

conciousness was compos mentis,

temperature 36.60C, pulse frequency 110

x/sec, RR 24 x/sec, lip mucosal dry,


warm akral, <2 sec CRT, vesicular

breath sounds , normal heart sounds (S1-

S2). Conservation of personal integrity:

the client lives with his parents who

always look after him and the client is an

only child. Conservation of social

integrity: When the client studies are

always watched by his mother and

sometimes with his father. Family hopes

for client immediately recovered and

was able to be normal like other children.

Post operation AA is more often seen

being carried by his mother because of

fuss. Trophicognosis: the risk of

deviation from fluid volume, acute pain,

damage to skin integrity and potential


Interventions include observing

nonverbal reactions from discomfort and

playing therapeutic. Evaluation results:

Devisit fluid volume does not occur, pain

is resolved, damage to skin integrity has

not been resolved, and infection does not

occur.

68


Case 4

An SZ (9 years 3 months) diagnosis of

open supracondyler fracture of the right

elbow, after ORIF insertion with K-wire.

Assessment (5 April 2016): Energy

conservation: BB 22 kg, TB 135 cm,

client's face looks less relaxed,

occasionally looks grimace, lack of

interest in the surroundings. After

surgery the child becomes fussy and

agitated pain scale (VAS / FACES) 2-3.

Eat a half portion, drink gradually.


regular pulse frequency 110 x / min,

moderate pain. The right hand seen a

fracture wrapped with bandage, no

seepage. Middle finger, ring and little

right can be moved and feel stiff, painful.

Conservation of personal integrity: the

client is cared for by parents, is the

second child of 3 siblings. Conservation

of social integrity: when the client's

assessment is always accompanied by

his father. parents hope their child

recovered quickly and could return to

normal like other children. Enforced

trophicognosis: acute pain, physical

mobility barriers, risk of injury

(contractures) and potential


Interventions include: conducting a

comprehensive assessment of pain,

teaching deep breathing techniques,

monitoring vital signs, and assessing the

client's ability to mobilize. Evaluation

results: pain is resolved, physical

mobility obstacles are overcome, injury

does not occur, and infection does not

occur.

Case 5

An AD (4 months) laparotomy surgery

release invagination ileotransversum

anastomosis resection, accompanied by

his mother with the main complaint of

bloody bowel movements since 1 day

before entered the hospital. A few days

ago, he vomits with the contents of ASI

(the client gets exclusive ASI). Bloating

and vomiting occur each time the client

is breastfed with a frequency of > 5 times

a day, with an amount that cannot be

predicted by the mother. Since yesterday

the BAB which was originally brown

turned red with thick mucus. When

checking at the clinic, they

recommended to be examined at Cikini

Hospital and said "folding of the

intestine" then referred to RSCM.

Clients receive paracetamol therapy

3x100 mg (k / p), Cefotaxime 3x200 mg,

Metronidazole 3x50 mg, and IVFD

69


maintenance D10 15 ml / hour and AS

6% 7 ml / hour.

Conservation assessment results: Energy

conservation: weight 6.5 kg, height 68

cm, client looks uneasy with pain scale

(FLACC Scale), fasting diet status,

general state of moderate pain.


compos mentis awareness, temperature

37.90C, pulse frequency 136 x / sec, RR

34 x / sec, slightly dry lip mucosa, less


warm acral, CRT < 2 sec, breath sounds

vesicular. Conservation of personal

integrity: the client from birth lives with

his parents who always take care of him

and the client is the second child of two

siblings. Conservation of social

integrity: when the client's assessment is

always attended by his mother, the father

only comes occasionally because he has

to work. The family hopes that. AD

immediately as before. Environmental

assessment: internal: Abdomen has

surgical scars, inserted NGT with solid

green production; external: current AD

was treated at the BCH in the

observation room. Complete blood and

electrolyte results: Hb: 9.82 gr / dl; Ht

30.9%; Leukocytes 13,200; Platelets

460,000, Na:: 134 meq / dl, K: 3.3 meq /

dl; GDS: 135 mg / dl

The hypotheses (nursing plans)

compiled in client related to pain

problems include: Energy conservation:

observe / monitor pain scale signs,

perform pain reduction techniques such

as touch, play / tell stories, singing.


maintain a comfortable position for

children, collaboration in administering

analgesics if needed: Paracetamol 3x150

mg.

On the last day an evaluation was carried

out (organismic response) with the

results: Subjective: the mother said the

child's fever no longer exists, no nausea

and vomiting, the wound was good and

was allowed to go home today by the

doctor; Objective: Energy Conservation:

the client drinks free breast milk, the

NGT drainage is concentrated green,

IVD fluid is stopped. Conservation of

structural integrity: consciousness level

(GCS) 15, warm acral, CRT < 2 seconds,

moist lip mucosa nausea, vomiting

absent, elastic skin turgor, stable

temperature, flat abdomen, supple,

intestinal noises, wound free from signs

of infection and closed clean kassa;

70


Analysis: devisit fluid volume; the risk

of nutritional imbalance is less than the

body's needs; pain; potential

complications of infection; Planning:

intervention stopped.

Integration of Theories and Concepts

in the Nursing Process

The Basics and Assumptions of the

Levine Conservation Model have three

main concepts: wholeness (holism),

adaptation, and conservation. Nursing

practice with models and conservation

principles focuses on conserving

patients' energy to achieve health and

recovery (Levine, 1991 in Alligood &

Tomey, 2010).

Wholeness is an open system and

combines its parts into a unit to deal with

changes in their environment.

Adaptation is a process carried out by an

individual in order to maintain the

integrity of his life by synchronizing the

internal environment with his external

environment by considering the patterns

and adaptability of each individual that

varies according to the time (Historicity),

individual character (Specificity) and

level of adaptation (Redundancy) .

Conservation is a product of adaptation.

Through conservation, individuals can

face obstacles, adapt according to their

uniqueness and maintain their integrity.

According to Alligood (2010), the

nursing process based on the Levine

model can be explained as follows:

Assessment, is the stage of collecting

data on changes that occur in patients by

considering conservation principles.

Nurses assess changes in the internal and

external environment of clients that can

hinder their ability to achieve overall

health. The nurse will assess changes in

the following aspects: a. Energy

conservation: a balance between client

energy expenditure and supply; b.

Conservation of structural integrity: a

defense system for the body; c.

Conservation of personal integrity:

client's feelings about self-esteem, and

personality; d. Conservation of social

integrity: a person's ability to participate

in social systems (family, community,

etc.)

Levine recommends trophicognosis as

an alternative nursing diagnosis.

According to Wilkinson and Ahern

(2012), nursing problems that can occur

in patients undergoing surgery include:

71


pain, anxiety, body image disorders,

delay in post-surgical recovery, risk of

infection, intolerant activity, and damage

to skin integrity.

The hypothesis, is a plan for

implementing nursing interventions that

aim to maintain the integrity of the

patient and promote their adaptation to

the current situation. The nurse will

make a hypothesis of the problem and a

solution that can be done, and then it will

become a nursing plan.

Interventions, carried out based on

conservation principles (energy

conservation), structural integrity,

personal integrity and social integrity.

Acute pain due to post-surgical incisions

is usually a collaborative problem that is

addressed, especially by providing

narcotic analgesics. As for independent

nursing interventions such as teaching

patients to divide the incision area while

moving, teach distraction techniques (eg.

by playing therapeutic) and other pain

management (Wilkinson & Ahern,

2012).

Evaluation, is an assessment of the

client's response to the intervention

provided. Evaluation is done by

reviewing the client's response. .

DISCUSSION

Avoid excessive fatigue and maintain

energy balance so that the incoming

energy in accordance with the energy

that comes out, is an effort for energy

conservation. Physiological children by

requiring surgical action cause imperfect

biochemical and metabolic cell work

which ultimately makes working vital

organs such as the heart, kidneys, lungs

and others imperfect so that energy

disturbances arise (Mefford & Alligood,

2011).

From the study of energy conservation to

the five cases, it is found that data

generally shows that clients get a

disruption in energy conservation in the

form of acute pain. Acute pain is an

unpleasant sensory experience arising

from acute tissue damage described in

such a way as to invasive procedures

(NANDA, 2012). In the short term, pain

causes a decrease in oxygen saturation

and a decrease in the work of the heart

which eventually results in

cardiorespiratory disorders.

72


The above conditions will affect energy

conservation due to the imbalance of

supplies with needs. But this does not

occur in all five cases. This is due to the

rapid and precise management of pain.

Pain management performed on all

managed clients is to provide therapeutic

play distraction techniques, monitor pain

scale, nonverbal response, vital signs and

provide analgesic therapy. Distraction

works by diverting the focus of the

child's attention to something, so that the

child is expected to "forget" their pain.

The recommended type of game is a

game that can be enjoyed by children on

the bed, because in post-surgical care

children usually experience restriction of

activity until the third day. Magnetic

numbers / letters on board, finger / hand

puppets, drawing / coloring are examples

of games that can be given (St. Louis

Children Hospital, 2014). Therapeutic

games are given starting from playing

dolls, listening to music, blowing

balloons, playing video games, coloring,

and storytelling (James, Nelson &

Ashwill, 2013). In infants, distraction

can be done by touching, swinging and

giving Non Nutritive Sucking (NNS)

(Sahoo, Rao, Nesargi, 2013).

Music therapy is used to help reduce

stress and pain in children. The results

show that music therapy can reduce pain

scores, respiratory rate and pulse and

reduce anxiety in children who are

undergoing lumbar puncture (Nguyen,

Nillson, Hellstrom, & Bengston, 2010).

Studies conducted by Athanassiadou,

Tsiantis, Christogiorgos, and Kolaitis

(2009) prove that puppet play in children

aged 4-6 years can reduce postoperative

aggressiveness and hyperactivity.

The implementation of therapeutic play

was also one of the resident innovation

projects while undergoing practice in the

BCh room at Cipto Mangunkusumo

Hospital. This activity was chosen in

order to carry out a holistic approach to

improve the effectiveness of pain

management. The responsibilities of

nurses in this regard include: ensuring

that patients get appropriate assessment

and management based on evidence-

based nursing, monitoring pain and

managing pain associated with

complications, educating patients and

families, documenting steps for pain

management, and seeking (applying)

standard for post-operative patient care

(Yuceer, 2011).

73


Another treatment that is done in dealing

with pain is collaborating with doctors in

administering analgesics. Several types

of analgesics are given to managed

patients with an intravenous route. Oral

analgesics are usually given after the

fifth day or for treatment at home. The

study by Chorney and Kain (2010),

showed that parents and children did not

get the recommended dose of treatment

at home. Therefore, adequate education

needs to be given before patients are

discharged (James, Nelson & Ashwill,

2013). The brain has a pain management

system ("analgesia"). There are several

types of transmitters involved in this

analgesia system, including dopamine,

serotonin and endorphins that have

morphine-like properties. Activating the

analgesia system can suppress peripheral

nerve signals (Hall, 2014). Morphine

receptors are released in the brain due to

feelings of pleasure, happiness and

comfort. This process occurs when

children play therapeutic, so this activity

is effective for reducing pain.

Conclusion

1. Pain is a problem that is always faced

by children after undergoing a

surgical procedure. The provision of

nursing care with the Levine

Conservation model approach to

children with post-surgical pain

shows that this model can be used to

optimize patient adaptability.

2. Therapeutic play has an important role

in handling non-pharmacological pain

in post-surgical children.

Recommendation

The application of the Levine

Conservation model in handling

postoperative child pain shows that

children can optimize their adaptive

abilities. The application of nursing

theory in practice is very helpful in

developing nursing science, especially

child nursing. Therefore nursing services

are expected can consider the

management of nursing care using the

approach of nursing theories.

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Utilization and Application (Fourth

edition). Missouri: Mosby.

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M., Zaree, .F., & Rasouli, M.

(2011). Effect of therapeutic play on

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J.W., (2013), Nursing care of

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McClain, B.C. (2006). Preoperative

anxiety, postoperative pain, and

behavioral recovery in young

children undergoing surgery.

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E.M.L., Kwok, M.C., & Lee, T.L.I.

(2014). Effect of therapeutic play on

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(2013). Application of Levine

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oxygenation fulfillment disorders in

the child care room. Children's

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(2011). Testing a Theory of Health

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on Levin 's Conservation Model of

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T., Ashok, C., & Bhat, S. (2013).

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ahinjs.01.2011.04.0100

75


FACTORS AFFECTING DEPRESSION IN HEMODIALYSIS PATIENTS

Yuanita Panma

Akademi Keperawatan Pasar Rebo, Medical Surgical Nursing Department


Jl. Tanah Merdeka no.16-18, Pasar Rebo, East Jakarta, Indonesia

ABSTRACT

Background: Depression is a common psychological problem faced by hemodialysis patient. Patient with

depression had lower obedience level in dialysis and also lower quality of life. This study aim to identification

factor affecting depression in hemodialysis patient. Methods: A cross sectional design was used with a total of

119 respondents. The bivariate data is analyzed with chi-square, one way anova and kruskal wallis test. The Beck

Depression Inventory (BDI) questionnaire, The Functional Assesment of Chronic Illness Therapy Spiritual

(FACIT Sp12) and The Medical Outcomes Study Social Support Survey (MOS-SSS) questionnaire to measure

depression, spiritual and social support. Results: There is no significant relationship between age, gender,

education, occupation, frequency of hemodialysis, time undergo hemodialysis, and social support with depression.

But there is a significant relationship between spiritual level (p-value 0.001) with depression. Conclusions: Based

on the findings, healthcare team can support spiritual level patient in the hospital, to reduce depression in

hemodialysis patient

Keywords: depression, hemodialysis, spiritual

Introduction

Chronic Renal Failure (CRF) has globally

become a serious problem where the disease

is able to affect the rates of morbidity and

mortality. In 2014, the rate of CRF patients

reached 111.2 per 1000 patients annually,

with a doubled number of mortality

compared to other patient types (United

States Renal Data System, 2016). In

Indonesia, the number of death of chronic

kidney disease patients in 2014 was 2.221

with the cardiovascular-related cause of

death at 59% (Indonesian Renal Registry,

2014).

Hemodialysis is one of treatment for CRF

besides peritoneal dialysis, and renal

ransplantation. In addition to the therapeutic

effect, hemodialysis can also have long-term

effects that can reduce the quality of life of

patients in the form of physical, psychosocial

and spiritual impacts. One of the

psychosocial effects faced by clients is

depression (Iyasere & Brown, 2014).

Depression is a psychological problem that is

often experienced by patients with end-stage

renal failure. Depression is also called

unipolar disorder, which is characterized by a

decrease in mood (loss of passion for activity,

depressed, unable to express feelings of joy)

(Sarlito, 2014). Dialysis therapy carried out

in patients with chronic renal failure causes

several changes including loss of bodily

functions, changes in role in the family, work,

physical strength, sexual function and

thinking ability. This reinforces the concept


76


of loss associated with depression. Besides

physiological changes, weaknesses that

occur, stress due to chronic renal failure, and

the need to undergo dialysis therapy for life

puts the patient at high risk for depression.

The prevalence of depression in advanced

stage CRF patients who undergo dialysis

(39.3%) is higher than the prevalence of

depression in stage 1-5 patients who do not

undergo dialysis therapy (26.5%) and in

patients undergoing kidney transplantation

(26.6%) %) (Palmer et al., 2013). The risk

factors for depression in general according to

Amir (2005) are gender, age, marital status,

geographical, family history, personality,

social stressors, social support, and not

working. Meanwhile, according to Arici

(2014) risk factors for depression are: young

age, female sex, white race, unemployment,

low income, low education level, non-

compliance with dietary restrictions, non-

compliance with Intra Dialytic Weight Gain

(IDWG), diabetes mellitus, stroke,

hypoalbumin, cardiovascular disease, and

other psychiatric disorders, estranged pouse,

social interaction disorder, estranged family

members.

Depression in CRF patients brings many

disadvantages. CRF patients who are

depressed can increase morbidity,

hospitalization and mortality compared to

CRF patients who are not depressed. Besides

depression can also cause non-compliance

with medication, dialysis therapy and low

quality of life (Palmer et al., 2013). A meta-

analysis study conducted by Palmer, et. al.

(2013) showed a strong relationship between

depression and all causes of death with a

relative risk of 1.59 with a moderate level of

heterogenity. CRF patients who experience

depression show low levels of adherence to

medication, dialysis regimens and low

quality of life which ultimately leads to

increased use of health care facilities and

increased mortality and morbidity (Kimmel,

Cohen, & Peterson, 2008).

The high rate of depression in hemodialysis

patients requires ongoing treatment. Early

detection of depression in hemodialysis

patients is an important first step to further

determine what factors influence the

occurrence of depression in hemodialysis

patients. But it has been fully assessed about

factors that have affected depression in

hemodialyis patients.

Methods

The design of this study is a cross-sectional

design, with consecutive sampling. There

were 119 CRF patients being respondent

with the inclusion criteria in this study were

able to communicate verbally using Bahasa

Indonesia and were outpatients who had

received hemodialysis for at least 3 months.

The research was conducted in May 2017 at

77


hemodialysis unit in East Jakarta. The

instrument used were the Beck Depression

Inventory (BDI) questionnaire to measure

depression and The Medical Outcomes

Study Social Support Survey (MOS-SSS).

BDI questionnaire has been translated in

Indonesian language by Waluyo (2014) with

alpha cronbach 0,822. While MOS-SSS

questionnaire has been translate by

researcher with alpha cronbach 0,907. This

study was approved by the research ethics

committee and the head of hospital. Before

the study begin, respondents were being

explained by the researcher, and all the

participants provided written informed

consent.

The data were analyzed using bivariate

analyses. The numerical data were presented

with mean values, with ± standars deviations

when they followed a normal distribution and

median (intequartile range) when they did not

follow normal curve. The normality test used

in this study was Kolmogorov-Smirnow

Independent t-test was used in order to

control the correlation between a quantitative

continous variables which followed the

normal qurve and a qualitative variable with

two categories. Chi Square was used to

control the correlation between two

qualitative variable with two categories. One

way annova used to control the correlation

between quantitative variables with normal

curve and qualitative variables. Kruskal

walis used to control the correlation between

quantitative variables with abnormal curve

and qualitative variables. A p-value lower

than 0.05 were considered as statiscally

significant. To perform the statistical analysis

the IBM SPSS Statistic version 13 (SPSS

Inc., 2003, Chicago USA) software was used.

Results

In this study, the mean age of the patients

was 54.95 years. The majority of the

respondents were males 60 person (50,4%),

senior high-school graduates 49 person

(41,2%), unemployed 88 person (73,6%),

undergoing hemodialysis twice a week 109

person (91,6%) and the mean duration of

hemodialysis was 32.67 months (SD: 32.28).

Characteristics of the respondents are

presented in Table 1. In table 2, majority

woman and man have no depression,

majority respondent with hypertension have

no depression, majority respondent with not

adequate hemodialysis have no depression,

majority respondent wih high school

education have no depression, majority

respondent which have hemodialysis twice a

week have no depression, majority

unemployed respondent have mild

depression.

Table 1.

78


Characteristics of Respondents and Hemodialysis Information (N=119)

Characteristic N %

Age

(M= 54.95, SD= 11.61, Min-Max= 27-81 years)

Gender

Female

Male

59

60

49.6

50.4

Education

Elementary

Junior High

Senior High

University

16

19

49

35

13.4

16.0

41.2

29.4

Occupation

Unemployed

employed

88

31

73.6

26.4

Frequency of HD

2 times a week

3 times a week

109

10

91.6

8.4

Dialysis adequacy

Not adequate

Adequate

117

2

98.3

1.7

Depression

Normal

Mild

Moderate

Severe

59

49

8

3

49.6

41.2

6.7

2.5

Spiritual level

Low

High

58

61

48.7

51.3

Time undergoing Hemodialysis

(M= 32.67, SD= 32.28, Min-Max= 3-192 months)

Hemoglobin Level (M= 7.58, SD= 1.49, Min-Max= 5.2-13.1mg/dl)

Inter Dialytic Weight Gain (IDWG)

(M= 2,13, SD= 1,10, Min-Max= 0-5 kg)

Ureum

(M= 59,89, SD= 25,06, Min-Max= 14-155 mg/dl)

Duration of hemodialysis

(M= 4.30, SD= 0,433, Min-Max= 4-5hours)

Quality of Life

(M= 62.51, SD= 1.72, Min-Max= 59.38-65.63)

Note: M= Mean, SD= Standar deviation, n= frequency, %= percentage

Table 2.

Relationship between gender, hypertension, hemodialysis adequacy, education, occupation, frequency of

hemodialysis, access of vascular, and spiritual level with depression (N=119)

Depression Total p-value

Not depression Mild Moderate Severe

n % n % n % n % n %

Gender

Woman 29 49.2 24 40.7 4 6.8 2 3.4 59 100 0.948

Man 30 50 25 41.7 4 6.7 1 1.7 60 100

Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100

Hypertension

Not

Hypertension

20 55.6 15 41.7 1 2.8 0 0 36 100 0.412

79


Hypertension 39 47 34 41 7 8.4 3 3.6 83 100

Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100

adequacy

Not adequate 59 50.4 47 40.2 8 6.8 3 2.6 117 100 0.406

adequate 0 0 2 100 0 0 0 0 2 100

Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100

Education

SD 6 37.5 8 50 2 12.5 0 0 16 100 0.082

SMP 7 36.8 10 52.5 0 0 2 10.5 19 100

SMA 24 49 22 44.9 2 4.1 1 2 49 100

PT 22 62.9 9 25.7 4 11.4 0 0 35 100

Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100

Occupation

Unemployed 38 43.2 40 45.5 7 8.0 3 3.4 88 100 0.10

6 Employed 21 67.7 9 29 1 3.2 0 0 31 100

Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100

Frequency of Hemodialysis

2x/week 55 50.5 44 40.4 7 6.4 3 2.8 109 100 0.836

3x/week 4 40 5 50 1 10 0 0 10 100

Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100

Access of vascular

Cimino 49 50.5 39 40.2 6 6.2 3 3.1 97 100 0.940

CDL 8 44.4 8 44.4 2 11.1 0 0 18 100

Femoral 2 50 2 50 0 0 0 0 4 100

Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100

Spiritual level

low 19 32.8 29 50 8 13.8 2 3.4 58 100 0.001

* High 40 65.6 20 32.8 0 0 1 1.6 61 100

Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100

*p<0.05

The bivariate analysis showed in table 3.

The results of the analysis of the relationship

showed there were no significant

relationship between age, gender, education,

occupation, time undergoing hemodialysis,

Hb level, adequacy of hemodialysis,

frequency of hemodialysis, access of

vascular, hypertension, social support and

Intra Dialytis Weight Gain (IDWG) with

depression. Only spiritual variable has

significant relationship with depression.

80


Table 3. Bivariate test

Variables Bivariate test p-value

Age One way anova 0.774

Gender Chi-square 0.948

Education Chi-square 0.082

Occupation Chi-square 0.106

Time undergoing hemodialysis Kruskal walis 0.937

Hb level Kruskal walis 0.404

Adequacy of hemodialysis Chi-square 0.406

Frequency of hemodialysis Chi-square 0.836

Access of vascular Chi-square 0.940

Hypertension Chi-square 0.412

Social support Kruskal walis 0.157

Spiritual level Chi-square 0.001*

IDWG Kruskal walis 0.787

*p <0.05

Discussion

In this study, some respondent had mild,

moderate and severe depression, while

majority of respondents were normal.

Previous studies conducted by Waluyo

(2014) obtained an average level of

depression in hemodialysis patients 18.76

(moderate depression). While research

conducted by Septiwi (2011) shows that

more respondents have mild depression

than those with moderate depression.

Majority of respondents had high spiritual

level in this study. This result in line with

study conducted by Spinale, et al (2008)

who found the mean score of spirituality in

hemodialysis patient was high (mean score

17,5 in range 0-20). Spirituality is important

for hemodialysis patients, to make a future

plans for life while they adapted with

hemodialysis therapy, and to faced the

prospect of death (Walton, 2007) . Because

the physical impact of chronic kidney

disease, medication side effects and dialysis

treatment were negatively affect patients

roles and activities and also challenges

patient’s spirituality (Arici, 2014; Mulder &

Sikken-Kersten, 2016).

There were no significant relationships

between age, education and social support

with depression in this study. This result in

line with research conducted by Astiti

(2014), where there is no significant

relationship between age, education, marital

status and family support with depression in

hemodialysis patients.

In contrast to the results of research

conducted by Setiawan and Novianti (2014)

found that there is a significant relationship

81


between the age of respondents with

depression, this is evidenced that in the age

group > 50 years experience high levels of

depression. In line with Nevid, et al (2003)

which states that depression is most

common in elderly patients, this is because

in the elderly there is a tendency to deny that

he has a problem because he may feel he is

not as fresh as before. Depression in the

elderly is also caused because the person

concerned suffers from several physical

illnesses so that they overlap, and then

depression occurs. In this study, more male

respondents suffered from depression than

female respondents. This is in line with

previous studies conducted by Rustiana

(2012). According to Ruli (2008) men are

indeed more susceptible to chronic kidney

failure than women, whereas from

depression women are more susceptible to

depression because women more often

recognize depression than men and doctors

are more able to recognize depression in

women.

In this study, there was significant

relationship between spiritual level and

depression in hemodialysis patient. This

result in line with previous study who found

that spiritual and religious beliefs correlated

with decreased levels of depression (Patel,

2002). Martinez`(2014) also found that poor

mental health and the presence of

psychological stress, sleep disturbance and

psychosomatic complaints were associated

with lower existential and spiritual

wellbeing. The other study conducted by

Davison (2013) found that spiritual is a

significant predictor of mental quality of

life. This can be explained by research

conducted by Kabat-Zinn, et al (1992)

which states that religious practices activate

various parts of the brain, including in the

structure of the frontal lobes. Activation of

the frontal lobes can lead to regulation of

the functioning of the autonomic nervous

system by connecting the frontal lobes and

the limbic, hypothalamic and amygdala

nerve. Religious practices such as

meditation are also related to immune

system. The autonomic nervous system can

reduce blood pressure, speed pulse,

respiration and cortisol levels and are

effective for reducing stress, anxiety and

panic.

Study conducted by Narayaanasamy (2002)

shows that spirituality is coping

mechanisms and also important factors that

contribute to recovery client. The

relationship of spirituality and activity is

explained in the mechanism that includes

central nervous system, neurotransmitters,

endocrine and immune systems. This matter

described when a person experiences stress

then the endocrine or system

Catecholamines consisting of dopamine,

norefinephrine and efinephrine will change

82


impulse stress function in cardiovascular

reactivation due to increase catecholamines,

this will reduce the body's immune system

regulatory reaction. When stress occurs

over a long period of time eating will

potentially produce negative health. That is

why religious practice can improve the

body's response to stress which has a

positive effect on health (Selbold, 2007).

Conclusion

For conclusion, there was significant

relationship between spiritual level and

depression. Based on the findings, as a

nurse we can promote better spiritual level

for the patient and family to reduce

depression in hemodialysis patient.

Reference

Amir, N. (2005). Depresi: aspek

neurobiologi, diagnosis dan

tatalaksana. Jakarta: Balai Penerbit

FK-UI.

Arici, M. (2014). Management of chronic

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Astiti, A. (2014). Analisis factor-faktor

yang berhubungan dengan depresi pada

pasien gagal ginjal kronik yang

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24664255

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R.A. (2008). Depression in patients

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Mulder, A., & Sikken-Kersten, L. (2016).

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pada pasien gagal ginjal kronik yang

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Soedarso Pontianak. Pontianak:

Fakultas Kedokteran Universitas

Tanjungpura.

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umum. Jakarta: PT. Raja Grafindo

Persada.

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spirituality and health. Journal

Bekaviar Medicine

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faktor yang berhubungan dengan

tingkat depresi pada pasien gagal ginjal

kronik yang menjalani tindakan

hemodialisa di Ruang Hemodialisa

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(2011). Spirituality and quality of life

in older people with chronic illness in

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dipublikasikan

Wijaya, A. (2005). Kualitas Hidup Pasien

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84


THE EVALUATION WITH MODEL CIPPO OF INDONESIAN NURSE

STANDARD COMPETENCIES (INSC) FOR INDUSTRY 4.0

Labora Sitinjak1,2, Burhanuddin Tola 1, Mansyur Ramly3

1 Universitas Negeri Jakarta, 2Akademi Keperawatan Husada Karya Jaya, 3 Universitas Muslim Indonesia


ABSTRACT

This study aims to evaluate the implementation of the INSC and the method of evaluation of research using model:

Context, Input, Process, Product, Outcomes. INSC current set of the year 2009, has not yet been evaluated for nearly

10 years, not to accommodate the new policy post 2009 and have not adapted new technology especially the industrial

revolution 4.0. The results showed that: Aspects of the context of moderate value, determination and implementation of

INSC in line with the expectations of the team's constituents. There are linkages the purpose of the determination and

implementation of INSC to the satisfaction of all stakeholders. Has not yet been adapted with the industrial revolution

4.0. Aspects of inputs include Human Resources with low-value, needs to be adapted, the industrial revolution 4.0. The

budget and facilities with a value of moderate, planned and would be sure but still need efficiency as the impact of the

use of the latest technology. Organizational structure involved with low-value, not to accommodate Regulation No.

90/2017 concerning the team compiling the INSC is the Power of Nursing Council Indonesia and need to be adapted

the industrial revolution 4.0. Planning with moderate value, needs to be adapted planning industrial revolution 4.0.

Design, stages and standard designation INSC with moderate value, still need to be adapted with the industrial

revolution 4.0. Aspects of the process includes the setting, implementation and monitoring of the evaluation of the value

of moderate, yet adapted the industrial revolution 4.0. Aspects of products with low value includes the availability of

Component competencies of Nurses in health care institutions as well as the curriculum available in nursing education

institutions are based on INSC and have not been adapted by the industrial Revolution 4.0. Aspects of the impact of

low-value, satisfaction of stakeholders has not been optimal. Novelty model development implementation and evaluation

renewable INSC against technology and current policies. Researchers recommend CIPPO renewable INSC and

adapted with the industrial revolution 4.0.

Keywords: Evaluation, INSC, Renewable

INTRODUCTION

The INSC 2009 conventional general nursing

competencies, and not demanding digitizing

competence of nurses. When this happens the

fundamental changes that the disruption in the

era of industrial revolution 4.0 which is a new

challenge for the nation and state of Indonesia

and the world. This has implications in the

provision of nursing services. Minister Hanif

(2018) states that a change in the era of big

data digitization with greatly impact on the

character of the work up to the necessary

competencies of workers also changed.

Nursing human resources need to adapt and

anticipate competence of the system as well as

new equipment and work procedures based on

digital technology. Literacy nurses on

digitization and big data is necessary to

improve the competence adapted to the

industrial revolution 4.0. That is INSC need to

be renewed.

Ariani A. P. (2018) stated that nurses

participate has its own challenges in the era of


85


globalization and digitization. Nurses today

need to compensate and adapt to the

surrounding environment based on the latest

technology. 4.0. Globalization of the

industrial revolution in the field of nursing is

a phenomenon that continues to roll in the

community. The presence of information and

communication technologies which accelerate

the process of globalization and the process of

working in the nursing field. The fact that

globalization touches to the entire field is

important in human life. Globalization 4.0

digitalization in the industrial revolution

creating challenges and problems that must be

faced, answered and resolved in an effort to

use globalization for the sake of people's lives

better.

Akhirfiarta BT. (2019), said that digital

literation is the ability to understand and use

information from a variety of digital sources.

This means that not only includes the ability

to read, but it takes a process of critical

thinking to evaluate the information found

through digital media. Nurses also require this

capability in the health service. INSC need to

accommodate the competence of nurses due to

digital literacy. The nursing workforce is

prepared for a digital globalization in the

industrial revolution 4.

Research Egbert N et al., (2018) says that

when nurses digital literacy in the various

domains in the advanced level will help to

more easily acquire the skills and other

competencies in life. Nursing services will

experience the efficiency and effectiveness

with high acceleration achieve service goals

when nurses terliterasi literacy and

digitization.

Research Methods

The method in this study is described in the

research design through two activities, namely

science conceptual and empirical drawn

through the data collecting.

86


Research design is Described as follows:

Note: INSC: Indonesian Nurse Competency Standards, C: Context, I: Input, Q: Process, P:

Product, O: Outcome. Evaluation design CIPPO of the INSC

Source: Modification from Stufflebeam, 2017

Results of the implementation and results of each of the constituent components are rated

displayed through the following description:

Table 1. Evaluation Assessment Guidelines

Scoring scale Rankings/ratings Description

1. Low Evaluation criteria are not

fulfilled or partially fulfilled all

below 50% of the number of

grains of criteria

2. Moderate Evaluation criteria is met,

≥50% of the number of grains

of criteria

3. High Evaluation criteria are met all

C Gathering information

about the contents and

objectives of INSC

Interpretating

information about the

objectives relevance of

the Nurse Competency

Standards Indonesia

Analyzing information

about the content and

related objectives of

INSC with user

satisfaction Gathering information

about the readiness to

implement INSC

RE

CO

MM

EN

DA

TIO

N

I Analyzing information


implement INSC

Information interpretation


implement INSC

implementation of INSC

P Gathering information

about the INSC

implementation process

Gathering information about the results of

INSC implementation

Gathering information

about the impact of

implementation on user

satisfaction INSC

P

O


about the INSC

implementation

process

Information interpreta-

tion about the INSC

implementation process

Analyzing the

information about the

results of INSC

implementation

Information

interpretation about the

results of INSC

implementation


about the impact of

implementation on

user satisfaction INSC

Information

interpretation INSC about the impact of

implementation on user

satisfaction

CO

NC

LU

SIO

N

information

Collection

information

Analysis

information

Interpretation

87


RESEARCH RESULT

Context

Table 2 Results of Context Evaluation of INSC

Aspects

Evaluated

Evaluation

criteria

Evaluation findings Ranked Decision

L M H

Analyze the

context

INSC

The contents of

the INSC ac-

commodate on-

going regulatory

and adapted to

the industrial

revolution

adapted & 4.0.

INSC has a comprehen-

sive reference, established

based on decision letter of

the Chairman of Indone-

sia's National Nurses Uni-

on. In the content INSC

has not been imaged com-

petencies adapted the

industrial 4.0.

Ѵ Evalua-

tion

criteria

are met

partly:>

50%

L: Low, M: Moderate, H: High, INSC: Indonesian Nurse Standard Competencies

The table above explains that INSC prepared

well through good references and

accommodate the laws, regulations and

policies related to standards of competence at

home and abroad but has not been reflected in

the statement competencies adapted to the

industrial revolution 4.0. INSC determined by

the Board's decision PPNI center and has the

aim of achieving the satisfaction of

stakeholders. Thus the results of the

evaluation context values are moderate.

Input

Table 3 Results of Input Evaluation of INSC

Aspects to be

evaluated

Evaluation criteria Evaluation findings Ranked Decision

L M H

HR in the

establishment and

implemen-tation of

INSC

Nursing HR capable of

digital literacy identity;

Infor-mation, media literacy

& data; learning & self-

development;

communication skills,

collabo-ration & parti-

cipation; tech-nical skills;

Digital

Creation, in-novation &

research

Establish and implement HR

INSC hasn't been able to

meliterasi digital identity;

Information, media literacy &

data; learning & self-

development; communication

skills, collaboration &

participation; technical skills;

Digital creation, innovation &

research

Ѵ Evaluation

criteria is

met: <50%

Budgetary

resources are used

in the Determina

Enough budget with the

latest technology-based

The budget fairly, but not yet

a digital-based management

system for the de-termination

Ѵ Evaluation

criteria is

met:> 50%

88


tion and implemen-

tation of INSC

of ef-fectiveness effi-ciency

accelera-tion & & INSC

implementation

The resources of

the facilities used in

the determination

and implementation

of INSC

Sufficient facilities with the

latest technology-based

management

Amenities enough, but not

optimal digital-based mana-

gement to accelerate the

efficiency and effectiveness of

the INSC

Ѵ Evaluatio

n criteria

is met:>

50%

Aspects to be

evaluated


L M H

The structure of the

organi-zations

invol-ved in the es-

tablishment &

implemen-tation of

INSC

KTKI have the ability to

literacy digitization

Permenkes not been enacted

Decree No. 90/2017 and has

not adapted to the industrial

revolution 4.0

Ѵ Evaluatio

n criteria

is met:

<50%

Planning the

structure of

organizations

involved in the

creation and

implementation of

INSC

Each of the parties involved

have the deter-mination &

im-plementation planning for

INSC of the industrial

revolution 4.0

Each party involved has the

determination and

implementation planning

INSC but not yet adapted to

the industrial revolution 4.0.

Ѵ Evaluatio

n criteria

is met:>

50%

Design of INSC Explain the description of the

INSC speci-fication for &

each category nurse &

descri-be competen-cies

adapted the industrial revo-

lution 4.0

Description and specification

INSC portrayed by nurses but

yet undefined category

competencies that have

adapted to the industrial

revolution 4.0

Ѵ Evaluatio

n criteria

is met:>

50%

Stages determina-

tion INSC

Stages of the determination

of the appropri-ate

procedures in progress

INSC& adapted the

industrial

revolution 4.0

Stages take place according to

the procedure INSC

determination but not yet


revolution 4.0.

Ѵ Evaluatio

n criteria

is met:>

50%

Standard-setting

INSC

The stan-dard setting of

INSC using the current refe-

rence & adapted the

industrial revolution 4.0

Standard-setting INSC not

accommodated related policies

set out above in 2009 and has

Ѵ Evaluatio

n criteria

is met:>

50%

89


not adapted to the industrial

revolution 4.0


The table above explains that HR enough but

Commissariat PPNI not participate in the

implementation of M & E Nurse Competency

Standards in Healthcare institutions. SDM not

yet have literacy towards digitalization. HR in

INSC determination has involved the relevant

stakeholders, but has not been involved in the

monitoring and evaluation PPNI

Commissariat INSC implementation in health

care institutions where nurses work so that the

value is low. Budget resources and facilities

are met but not yet adapted to the industrial

revolution 4.0 so that the value is moderate. in

the structure of the organizations involved has

not imposed Health Minister Decree No.

90/2017 and has not adapted to the industrial

revolution 4.0 so that the value is low.

Planning each unit involved in the

organizational structure has the determination

and implementation planning INSC but not

yet adapted to the industrial revolution 4.0 so

that the value is moderate. INSC

determination procedures and implementation

are met but have not yet adapted to the

industrial revolution 4.0, so the value is

moderate. INSC design has made it clear

description and specification INSC in each

category nurse but has not been reflected in

the competencies related to digitalisation, thus

ranking moderate. INSC stages of adoption

and implementation of compliance

procedures, but have not been adapted to the

industrial revolution 4.0, so nilaitnya

moderate. Standard-setting INSC have used a

complete reference at the time but have not yet

adapted to the industrial revolution 4.

Process

Table 4 Results of Process Evaluation of INSC

Aspects

Evaluated


L M H

Stages of the

process of

implemen-tation

INSC

Stages of the process of imple-

mentation of appropri-ate INSC

according to Standar

Operational Prosedure &

adapted to digitization

INSC implementation process

stages according to the procedure

but has not adapted to the industrial

revolution 4.0

Ѵ Evaluation

criteria is

met:> 50%


90


The above table describes the stages of the implementation process INSC according to

the SOP, but have not yet adapted to the industrial revolution 4.0 so that the value is

moderate.

Product

Table 5 Results of Product Evaluation of INSC

Aspects Evaluated Evaluation criteria Evaluation findings Ranked Decision

L M H

INSC Products: Nurse

Competency Standards

in health care

institutions and

curricula in nursing

education institutions

based INSC

There are nurse

competency standards in

nursing care institutions by

INSC and provided

curriculum at every

education category

nursing by INSC and


revolution 4.0

There are nurse

competency stan-dards in

nursing care institutions

by INSC and provided

curriculum in each

category of nursing

education based INSC

but not optimal adapted

to the industrial 4.0

Ѵ Evaluatio

n criteria

is met:>

50%


The table above explains that INSC

product on health care institutions already

have standards of competence which are

based on INSC and on nursing education

institutions provided curriculum refers to

the optimal INSC but not yet adapted to the

industrial revolution 4.0 so that the value is

moderate.

Impact

Table 6 Results of Impact Evaluation of INSC

Aspects

Evaluated


L M H

Stakehol-ders

satisfaction on

the performance

of INSC

Nurses have the

competence managed

to give great

satisfaction to

Stakeholders

Leaders healthcare or nursing

convey that it is not satisfied

with the performance INSC in

improving the quality of

health care in institutions

Healthcare

Ѵ Evaluation

criteria is

met: <50%

91



The table above explains that the implications INSC to satisfaction of stakeholders are still not

optimal, so the value is low.

Discussion

Below is a discussion of the results of the

study as follows:

1. Context

The findings of the evaluation aspects of

the context, INSC prepared well through

good references and accommodate the

laws, regulations and policies related to

standards of competence at home and

abroad but has not been reflected in the

statement competencies adapted to the

industrial revolution 4.0. INSC

determined by the Board's decision PPNI

center and has the aim of achieving the

satisfaction of stakeholders. Thus the

results of the evaluation context values

are moderate. The research result

Halcomb E et al., (2016) says that the

testing and assessment of standards of

competence in continuing to strengthen

and develop competence of nurses in

primary health care. It is very necessary

to improve public confidence in the

quality of nursing services.

INSC is continuous and regular basis

must be investigated and evaluated to be

developed that are adapted to the

development of science and technology

and is capable of responding to global

challenges. INSC expected to raise the

dignity of nursing jobs nursing services

so that people recognized as noble and

scientific work. The nurse caring for the

individual human being in need of a

helping hand and heart services of a

competent nurse. Competent nurses are

nurses who carry out nursing care based

Caring. Caring is the essence of nursing

services. INSC should be able to improve

the health status of the community, nation

and state of Indonesia. Nursing personnel

with the greatest number of health

services are expected to bring up the

quality of service at the institution where

the nurse worked.

2. Input

The findings of the evaluation of the input

aspects, human resources PPNI

Commissioner's pretty but not participate

in the implementation of M & E Nurse

Competency Standards in Healthcare

institutions. SDM not yet have literacy

towards digitalization. HR in INSC

determination has involved the relevant

stakeholders, but has not been involved in

the monitoring and evaluation PPNI

92


Commissariat INSC implementation in

health care institutions where nurses

work so that the value is low. Budget

resources and facilities are met but not yet

adapted to the industrial revolution 4.0 so

that the value is moderate. in the structure

of the organizations involved has not

imposed Health Minister Decree No.

90/2017 and has not adapted to the

industrial revolution 4.0 so that the value

is low. Planning each unit involved in the

organizational structure has the

determination and implementation

planning INSC but not yet adapted to the

industrial revolution 4.0 so that the value

is moderate. INSC determination

procedures and implementation are met

but have not yet adapted to the industrial

revolution 4.0, so the value is moderate.

INSC design has made it clear description

and specification INSC in each category

nurse but has not been reflected in the

competencies related to digitalisation,

thus ranking moderate. INSC stages of

adoption and implementation of

compliance procedures, but have not

been adapted to the industrial revolution

4.0, so the value is moderate. Standard-

setting INSC have used a complete

reference at the time but have not yet

adapted to the industrial revolution 4. 0

and yet accommodate the policies set

after the year 2009 until now, so the value

is moderate. Acreditation research results

ANCC (American Nursing Credentialing

Center), 2017 said that the nurse's

competence needs to be evaluated and

accredited continuously. Nurses Council

of Indonesia has been established through

the Minister Regulation No. 90 in 2017,

especially in chapter 8. The function of

the council is the setting, the

establishment and development of

nursing personnel in performing nursing

practice to improve the quality of health

services. The task for the nursing council

registration nursing staff, nursing

personnel conduct training run practice,

develop national standards for nursing

personnel, set standards of practice and

competence standards and enforce

discipline health workers practice nursing

personnel. In this regulation have been

accommodated consistency INSC makers

will monitor and evaluate the

implementation of INSC and discipline

practices nursing personnel. Need to

provide a tool or tools that purpose of this

regulation will be achieved in improving

the health status of the community.

3. Process


the process, the stages of the

implementation process INSC according

to the SOP, but have not yet adapted to

the industrial revolution 4.0 so that the

value is moderate. Aspects observed in

93


the implementation process is

consistency in the implementation INSC

start of the discussion, preparation,

determination, dissemination and

implementation as well as monitoring and

evaluation. Discussion process done well

through discussions in the meetings by

INSC maker teams with experts nursing.

After a discussion of the preparation and

adoption INSC done. Determination

INSC occur after discussion in the

national congress as the ultimate legal

power INSC. Socialization was carried

out from the center to the regions.

Monitoring and evaluation processes will

also be something very important in the

process of sustainable development so

that INSC is always renewable. INSC

latest procurement will be able to satisfy

stakeholders. INSC renewable

procurement process will make nurses

carry out the task with confidence and

dignity.

Acreditation research results ANCC

(American Nursing Credentialing

Center), 2017, said that individual nurses

who have successfully completed a

course of education or competence as

well as a certificate of competence, does

not necessarily have the ability or

competence in nursing practice.

Individuals who are successful and

recognized expertise or competence in

nursing are individuals who have

successfully implemented these

competencies in the execution of daily

tasks. These competencies should be

developed and researched in order to

improve the quality of care is continuous.

4. Product

The findings of the evaluation aspect

INSC product on health care institutions

already have standards of competence

which are based on INSC and on nursing

education institutions provided

curriculum refers to the optimal INSC but

not yet adapted to the industrial

revolution 4.0 so that the value is

moderate. INSC has been implemented at

each institution nursing services.

Consistency is the case with the INSC

implementation monitoring and

evaluation directly by every individual

nurse leaders are at work. In the future

these products will be implemented by

council consistently ranging from

manufacture to INSC development.

council consists of: Elements ministry

held government affairs in the health

sector as much as one person; ministry

which held government affairs in the field

of higher education as much as one

person; organization of the nursing

profession as much as two people;

college of nursing as much as two people;

94


association of nursing education

institutions as much as one person;

association of health facilities as much as

one person and community leaders as

much as one person.

Results of research-Qin Fang Wu et al.,

(2014) expressed about the consistency

and effectiveness of achievement of

competence set out in the curriculum.

Likewise, the results of research Ruth S

et al (2018), with the title of Entry-to-

practice public health nursing

competencies: A Delphi method and

knowledge translation strategy in the

journal Nurse Education Today. In this

study are described: Background to

sustain and strengthen the contribution of

nurses in public health services and

society in the 21st century, most still rely

on the quality of nursing education.

Likewise, the results of research Egbert N

et al., (2018) with the title: Competencies

for nursing in a digital world.

Methodology, results, and use of the

DACH-Recommendations for nursing

informatics core competency areas in

Austria, Germany, and Switzerland in the

Journal of NCBI (National Center for

Biotechnology Information). In this

study, submitted that nurses require

understanding or digital literacy: the

ability to live, learn, work, participate and

thrive in a digital society. Humans

become digital literacy which involves

the development of skills, attitudes,

values and behaviors that can be

categorized as: Digital Identity, welfare

and safety, communication, collaboration

and participation, teaching, learning and

self-development, technical capability

information, make data and digital media

literacy and innovation. Digital literacy in

the various domains in the advanced level

will help to more easily acquire the skills

and other competencies in life.

5. Impact


impacts, implications INSC to

satisfaction of stakeholders are still not

optimal, so the value is low. Research

results of Silaban G. et al., (2015) in the

journal Public Health Andalas entitled

Draft Competency Based Performance

Appraisal System Emergency Room

Nurse at XX Hospital Medan. In the study

said that some public hospitals (RSU) in

the field still have not meet the standards

Key Performance Indicator (KPI) of IGD,

one is RSU XX Medan. Needed

emergency nurse performance

assessment which is based on

competence, in order to provide the best

performance. Thus competence is

continuous, nurses need to be evaluated

to create optimal satisfaction for

stakeholders.

95


Results informant interviews indicate that

the implementation has not been

satisfactory INSC party stakeholders.

Generally, participants said about their

satisfaction level is not optimal. This

shows that the adoption and

implementation of INSC still need to be

improved so that the impact is more

positive for policy makers, users and

stakeholders and other policies that will

benefit the community nursing service

recipients. In particular in the current era

of the industrial revolution 4.0 by

digitizing and big data encourage nurses

adapts itself to the disruption.

INSC model development

From the discussion above authors describe

the novelty of this research is the development

and implementation of INSC pricing model

based on the evaluation Cippo as follows:

96


Findings and discussion of the evaluation

results summarized as follows:

1. Context

a. INSC policies need to accommodate

the latest as the foundation for

preparing the contents

b. INSC future needs of renewable and

adapted to the industrial revolution

4.0, digitizing and big data.

c. Availability of nurses who are

competent and have the digital

literacy to meet the expectations of

society and the government.

2. lnput

a. In the aspect of human resources and

organizational structure needs to be

adjusted to the Presidential Decree

No. 90 in 2017 and HR literacy nurses

on digitization.

b. Budget and facilities required in

setting up the implementation of

planned and fulfilled INSC well but

managed digitizing cloned partitions

for efficiency and effectiveness.

c. INSC determination and

implementation planning, design

INSC, stage-setting and standard-

setting INSC INSC pretty good, but

need to be adapted to the industrial

revolution 4.0.

3. Process

Aspects of the process of

analyzing the discussion, preparation,

C: Context Fill INSC-related policies to

accommodate the latest INSC

I: Input Human resources, budget,

facilities, structures involved, planning each involved in the

structure, design, and standard-setting stage INSC

adapted to the industrial revolution 4.0

P: Process INSC implementation process

adapted to the industrial revolution 4.0

P: Product - Nursing education

curriculum refers adapted INSC industrial revolution 4.0

- Standards of competence in health care institutions that have adapted to the industrial revolution 4.0

- Nurse training is continuous on improving the competence of renewable

Nurses always will produce competent

O: Outcome Stakeholders

optimum satisfaction

for the performance

of INSC

97


determination of content, implementation

and monitoring and evaluation INSC.

Implementation stages of discussion, the

preparation, establishment,

implementation and monitoring and

evaluation carried out according to the

procedures in force at the time. The

researchers concluded that this aspect of

the process is at a moderate ratings. All

stages performed well but need to be

adapted to digitization.

4. Product

Standards of competence and curriculum

of nursing education requires competence

statement digitization and need to be

adapted to the industrial revolution 4.0.

5. Impact

a. Impact determination of content

and implementation of INSC have

a positive effect for the institution

of nursing education as the

cornerstone of the establishment

of the learning curriculum

b. Impact determination of content

and implementation of INSC have

a positive effect on the health care

institution as guidelines for the

preparation of job descriptions,

performance measurement

cornerstone of nursing personnel.

c. The level of satisfaction of

stakeholders on the

implementation of INSC not

optimal.

Recommendation

The Council of Nurses INSC Indonesia

needs to improve the quality of the content

establishment, implementation, monitoring,

evaluation and development INSC as follows:

1. Discussion, assessment, dissemination,

implementation, evaluation and

development INSC future will be

coordinated by Council of Nurses

Indonesia in accordance with Presidential

Decree No. 90 in 2017

2. Literacy nurses towards digitization in the

era of the industrial revolution 4.0 needs

to be done through the implementation of

nursing education and nurse competence

in health care institutions

3. Develop and establish and monitor the

implementation of the adapted INSC

industrial revolution 4.0.

References

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Dr. Soetomo Hospital in Surabaya,

http://journal.unair.ac.id/ download-

fullpapers-lna3e16b8d81full.pdf,

accessed on 18/8/2019 at 16.30

ANCC Acreditation (American Nursing

Credentialing Centre), 2017, Nursing

Skills Competency Program:

http://journal.unair.ac.id/%20download-fullpapers-lna3e16b8d81full.pdf

http://journal.unair.ac.id/%20download-fullpapers-lna3e16b8d81full.pdf

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Application Handbook,

nursecredentialing.org

Ariani A. P (2018), Nurses should be

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